Sick Call At The TMC (Troop Medical Clinic)

The soldiers were waiting for me in great numbers as soon as I arrived.  Of course not for me personally, they are waiting for the "doc" and trying to take advantage of their down time.  In return for joining the military and agreeing to serve wherever they are sent soldiers are assured that they will be provided with all their basic necessities including medical care.  Getting it to them is the responsibility of their officers while in this case they simply have to show up.  Once they've checked in they can take advantage of their down time.  Soldiers often have to work extremely hard but they are also accustomed to being asked to wait and almost no one is worried about how long the wait is going to be.  They've been accounted for and it's all out of their hands. 

 

Sick call means you show up and wait to be seen since the TMC (Troop Medical Center) doesn't make appointments.  Military medicine is now highly computerized and it's gone from being a backwater medical service to among the most advanced and highly computerized medical services anywhere but at this location everyone is urged to come at 8am when we first start seeing patient because it's first come first served. It's all very similar to how most things are done in the army and nobody is surprised.

 

I'm staffing what's known as a Level 1 Battalion Aid Station (BAS)  but in this setting it's also referred to as the TMC .  This is the entry level medical facility and there is also a small army hospital, know as a level 2 in the vicinity


During a war when the front is actually changing the entire facility is packed up in trucks and can be on the move rapidly.  During hostilities you don't wait until the wounded arrive you anticipate it.  Ideally the the medical command is briefed as to when an offensive is going to take place and they should try to set up their BAS as close to the front as possible so that you're fully staffed and waiting for the first wounded to arrive.  Fortunately, even though there are explosive devices and some firefights on the roads daily, Camp Adder & Tallil Air Force Base has a very secure perimeter and we only have to infrequently worry about rockets and mortars.  

There is a lot of history associated with my base.  The building I'm in was part an Iraqi Air Force complex and was reportedly part of the operations center for Sadaam Hussein's cousin and henchman, Ali Hassan al-Majid, the notorious Chemical Ali.  The planes that dropped poisonous gas on the Kurds as well as on Iranian targets during the 1980 - 88 Iraqi-Iranian War took of from Tallil.  What a terrible history but at least this section is now a health care facility.

At enormous expense all building including our housing units have been surrounded with 20-25 foot high reinforced concrete walls known as T walls, which are lifted and positioned by cranes to protect against rockets and mortars.  In addition to the T walls all structures have nearby bomb shelters utilizing the reinforced concrete that are also covered with layers of sandbags.

My Aid Station (or TMC) like many facilities is understaffed.  The doctor I relieved actually got on the same military plane to leave Iraq that I arrived on so we never got to even speak to each other much less sign off.  There's supposed to be a physician plus at least two Physician Assistants but for now I'm it. 


On the day I did arrive I was very pleased to learn that the army hospital has assigned one of their physicians, Dr Findlay, to staff the TMC until I got set up. When I met Dr Findlay I could immediately see that she is simply a class act and a great physician.  She's an experienced army physician and one of those very special people.  She has three young children including an infant and her husband is also an army physician.  She has several more months at Adder but says when that's over she'll be leaving the army so she can spend more time with her children.

Given that they're so short of medical providers I'm surprised that they're allowing so much time for my orientation until I discover what I believe is the answer is.  The answer is computers & technology.  I soon learn that in order to start seeing patients I need to be up and running with either four or five different computer systems each with it's own user ID and passwords.  I've also never seen such requirements for user names & passwords. My main password has to be entered twice for each individual patient and it has 16 separate key entries, which must include several upper case and lower case letters plus several additional symbols.  Only the army could create such a monstrosity.

The soldiers are waiting for their doctor to get ready and I'm over ripe to finally get started.  I've gone through all the years of my medical training and went on to run my own practice for eighteen years.  I turned eighteen in 1969 while the Viet Nam war was escalating but Uncle Sam left me alone because I was registered at City College of New York. 

Even though I was at best a fair student who consistently underachieve the student deferment held and I was never drafted.   Long after the Viet Nam war ended I somehow completed my undergraduate education and went on to become a physician and three months ago I recertified in Family Medicine for the third time.  Six years after 9/11 I crossed paths with a National Guard medical recruiter who looks me in the eye and tells me that the army desperately needs physicians like me. The deal is one weekend a month, two weeks a year and 120 days of active duty with 90 days in theatre if there's a national emergency and I'm called up.  Yes, there is a national emergency now, the same one that started on 9/11.

The army would still take a full year to process my application and slowly things start to move.  I'm sworn in and I go to my drills for almost a year and I'm scheduled for my four weeks of basic training.  The weekend drills do not seem significant and my life really hasn't changed one bit until months later when I'm given a deployment date and then it all changes rapidly.  The past was all an abstraction with privileges, then preparation and now it's show time.  I'm pretty good with the first three computer systems, the fourth I'm still sketchy with and I'm not going to get oriented on the fifth one until the following day.  I'm now in "theatre" and I've decided that I'm going to start in the morning and everything else I'll learn on the job.  

There are four medics who will be working with me and they are the greatest.  They've been in the infantry and some of them have worked in the convoy escort vehicles. They couldn't be more welcoming and seem so glad that there's a physician for this TMC.  Meanwhile I'm trying to express to them how honored I feel to be able to work with them and contribute something to this war which will have lasted ten years before my enlistment is over.  This will be my first day treating patients in a war zone and for the moment everything has come together to make this a first day for me unlike any other first day of my career.  I want to give thanks that I have been allowed to treat our soldiers and I pray that I will meet their needs.


The day has flown by and I hardly realized that I should be taking breaks. Every day is similar and if it wasn't for all these computers and the passwords that take forever to enter I would be even more productive.  Now I understand why it's called An Army of One".