Out in the Field

Despite my best intentions, I've been neglecting the blog world. Sorry about that. I can't decide if it's that I've been too busy or that things are too routine. Let's just go with that I'm too lazy.

A few weeks ago, though, we did something out of the routine--we went out the field! Kinda. Alpha Company had their Culminating Exercise, which is when they go to a simulated village, in this case in Mali, and demonstrate that they learned something in all of their training.

In theory, anyway.

The week started with the firing range and mass casualty situations, which were to assess how well the medics could triage and determine who to treat first. Overall, they didn't do too well. One medic spent all of her time on a head casualty that should have been triaged as "expectant" (as in, expectant to die). Another went straight to the first casualty and didn't look any further. In other words, we have some work to do.

On days 2-4, they were out in the simulated village in "Mali" (really a remote corner of Ft. Stewart). I got to play a doctor with MSF (Medecines Sans Frontieres, or Doctors Without Borders), which has a very strict "we don't work with the military--any military" policy, so I played that to the best of my abilities. This is me yelling at one of the team leaders (my friend Dan) for their actions throughout the village and how we just wanted them to leave.

The other two officers in my office, MAJ Greifenstein, the environmental science officer (in red) and CPT Avriette, the veterinarian (the girl) also got to play parts, both as USAID scientists (he a soil science, she a vet... we were really imaginative). In the course of playing a soil scientist, Griff was digging holes, and instead of the teams asking him what he was doing (which they were supposed to do), they reported him for burying land mines and declared entire roads off-limits. Not quite the reaction we were going for.

In all, it was a fun week in the field (because, well, we weren't in the office), but the teams have a lot to learn about operating in Africa. Maybe I have an advantage, because I've only been on "peacetime missions" and no deployments to Iraq or Afghanistan. I don't really have a combat mindset, but all the team members have been deployed in combat situations, and that's what they revert to when they think of going overseas. As I've said in multiple conversations to multiple people, Africa is not Iraq or Afghanistan. Not only that, but civil affairs shouldn't be about combat. It's not about going into a village with weapons, ready to shoot the bad guys. It's about getting to know people and winning trust, and not assuming that there's a bad guy behind every door.

It's a work in progress, I guess.

More Medic Training and Some Random Musings

I actually started to write this post on Friday, but then I realized that I didn't have everything I needed to write it. By that I mean the link to the article I wrote... Keep reading and that will make more sense.

Before I left for ACPM, we had Dr. Likita Aminu from the CDC come over to talk to the medics about hepatitis. Dr. Aminu is originally from Nigeria, and met LTC Gardner in December at an African culture event in Savannah. Because LTC Gardner can talk anyone into anything (he is, without exaggeration, the type who would be able to sell ice to Eskimos if he wanted), Dr. Aminu agreed to chat with the medics. Since he had done research on hepatitis in the Coastal Region of Georgia (where we live), and hepatitis is an issue in Africa, that's what he talked about.

And here's the link to the article I wrote about the training:

http://www.stewart.army.mil/homepage/news/news8.asp

Now onto my random musings. For the second half of last week, I was in a pretty annoyed mood. I think it started on Wednesday, when we had a Command and Staff meeting. Command and Staff is pretty awful to begin with--each of the staff sections talks about what's going on in that section. It's great if you really care about how many humvees are due to be serviced or whose evaluations are due. If you don't, it's about an hour and a half of torture. Well, because the conference room table is only so large, I don't have a seat at the table, but I do have a slide (as in, one PowerPoint slide) to brief, and that's the medical readiness of each of the companies. To make an already long story somewhat shorter, before the meeting started, I was trying to find the right chair to pull into the corner of the room, the entire time thinking, "I went to four years of medical school and three years of residency for this?" Yes, a bit egotistical, perhaps, but that is what I was thinking.

I think part of that was the fact that I was just at a conference, hanging out with the people I used to work with, which was a nice little reminder of how well I used to have it. In residency, my only obligations were to learn as much preventive medicine as possible (and stay up to date with all my Army required trainings, of course). Now, I see routine complaints (boring), track who is due for which vaccines or blood work (boring), and only rarely get to do anything preventive medicine or tropical medicine related (yay!).

I guess the point of that is, going to such conferences remind me that I do like the Army, but that I think I'll be happier if I leave FORSCOM and go back to MEDCOM, where doctors typically get to do what they're trained to do.

We'll see what happens.

Change of Command, Staff Assistance Visit, and Board Exam Results

The last two days have been pretty busy for the medical section of the 82nd Civil Affairs Battalion. We started our day yesterday with a Staff Assistance Visit (SAV) from our parent brigade, the 85th CA Brigade. I think the original plan was that all of our counterparts would come over from Ft. Hood, but in the end, it was just the brigade veterinarian and environmental science officer (so, my counterpart wasn't there). The vet, who is the head of the med section at brigade, explained to us things that he expected from us and updated us on live tissue training (LTT).

To back up for a second, LTT is essentially doing trauma training on animals, in order to prepare Soldiers to do trauma care on Soldiers in combat situations. To explain what happens in very simple terms, a goat will be shot and then it'll be up to the Soldiers to keep it alive for, say, four hours. This is done throughout the Army, but usually just for medics and just before deployment to Afghanistan. In the Special Forces community, where much of our leadership is coming from, all of the team members participate, because they operate in small teams (like we do), and if something happens to their one medic, the other team members need to know what to do. Summing up many months of discussions and requests, the battalion wants us to do LTT. Well, getting permission to do that isn't nearly that easy. The brigade vet explained the process that's going to happen, which is going to involve paperwork sent up the Pentagon and probably three + years of work in progress. In other words, not the answer we would have liked, but we finally have an answer when people ask.

After a couple of hours of meeting with them, we had a change of command ceremony for Headquarters and Headquarters Company (HHC). Since I am in HHC, I should have been in the formation, but because of our SAV, we didn't have time to rehearse, so we just watched (actually, our command sergeant major told us to sit in the second row of the VIP section, so that was kinda nice). It was ridiculously cold (our only cold day; it went back up to the mid-60s today), so I was glad to be able to sit and wear my fleece jacket, instead of standing at attention in formation.

Here's the outgoing company commander, CPT Scott Cummings, pass off the guidon (the flag) to LTC Gardner to signify handing over his command:

And below is LTC Gardner handing the guidon off to MAJ Will Richardson, the new HHC Commander.

I had never seen a change of command ceremony before, so it was interesting to see. And I'm happy for both Scott, who gets to move to B Company to be a team leader, and MAJ Richardson, who is going to be bringing his civil affairs expertise to the company command.

After all that, I finally had a little bit of time to do my job (imagine that), and then our counterparts from brigade wanted to go out in Savannah. MAJ Escajeda, the environmental science officer, had been stationed at Ft. Stewart before, so she knows Savannah. We went to Pirate's House for dinner (great food) and then did a hearse ghost tour just for fun. It was all very hokie, but we did get to hear some stories, like the involvement of the Candler Hospital in the yellow fever outbreaks in the 1800s and during the Civil War. And it's supposedly haunted, but we didn't see any ghosts. Just a really old hospital (the oldest in Georgia and the second oldest in the country, according to our tour guide).

It was quite a night out (I got home at 1 this morning), and then I had clinic this morning (ugh). When I got home, though, I had some good news waiting for me in my mailbox: I passed my board exam! It was a pretty poorly written exam, but apparently everyone who took it felt the same way, because I finished the two pieces of the test at the 95th and 98th percentiles. The certification lasts for 10 years, so I am done taking exams until 2022. That's certainly a relief!

Activation, Triathlons, Medical Evaluation Boards, and Everything In Between

Yes, it's been a while since I've updated. A very long while. I could say I've been busy, but really, I think I've just been lazy. Here are some of the things that have happened since my last post:

1) The 82nd Civil Affairs Battalion was activated on 27 September 2012. The week leading up to the activation, we had rehearsals almost every day, which was tedious, but there were still some good times:

This was one of the rehearsals, obviously. I don't know what led to this; I just walked up as they were doing pushups, so I figured it was as good a time as any to take pictures.

And this is 2LT Alex Sasseman, the Adjuvant General (officer in charge of personnel). She had the delightful job of running in front of formation at the sound of the Adjuvant's Call, so that was actually quite a bit of running in the course of all of those rehearsals.

This was after the activation, when LTC Gardner (in the middle) cut the cake with his Zulu sword.

2) Triathlons. I ended up doing two triathlons this summer, one on the beach on Hilton Head Island and one in Florida at Amelia Island. The one on Hilton Head was actually pretty difficult, because not only was everything on the beach (including the bike), but it was August and very hot and sunny. The one at Amelia Island ended up not being a triathlon (they cancelled the swim due to riptides), but was still a good race. I ended up winning the military division for the sprint distance (16 mile bike and 3 mile run). I also did a 2.5 mile ocean swim in Jacksonville, FL and a few runs, the most recent of which was the Rock n Roll Half Marathon through downtown Savannah yesterday (I started too fast in efforts of finishing under 2 hours and ended up dying around mile 8, coming in at 2:21. I'll try not to repeat that mistake at my next half in December).

This was at the costume run the Friday before Halloween. I had to buy the red running shoes special for the costume.

3) Medical Evaluation Boards (MEB). This is not fun. As part of the "post tax", as LTC Gardner calls it, once a week I see soldiers from the Military Police in clinic to determine if they need to go to the MEB. These are soldiers who have been on limited duty profiles for an extended period of time and aren't making any recovery (or not enough). For some, it's just a matter of writing a referral to see a specialist (orthopedics, neurology, etc). For others, it's time for a long conversation about not being fit for the Army any more. It's not as simple as writing the referral for the MEB, unfortunately. The entire process takes anywhere from 6-12 months and involves many meetings and evaluations from people from the Army and the VA and likely more that I'm forgetting. I have no idea how many of the people I refer will actually be found to be not fit for duty, but this is what I do.

4) Parents came to visit. We explored Savannah, went hiking in a state park, Jekyll Island, and went up to Charleston, SC and Ft. Sumter. It was good to have them here (even though my guest bed didn't arrive until after they left).

5) Disney World. It's the most magical place on Earth. Need I say more?

6) Firing range. For three days last month, I got to hang out with the team leaders and senior NCOs from Alpha Company at the firing range. It wasn't much fun, but I did qualify on both the M4 (rifle) and M9 (pistol).

And I got a little burned by some ejected brass. Like I said, not much fun.

I think that's about it. I'll try not to let it be another three-ish months before I update next.

82nd Civil Affairs Battalion, Ft. Stewart, GA

Again, I'm a bit behind on posting big news. Last Wednesday (as in, a week and a half ago), I received word that I will be becoming the preventive medicine officer for the 82nd Civil Affairs Battalion of the 85th Civil Affairs Brigade. For those of you confused about what the difference between a battalion and brigade is, here's a chart for you:

The 85th Civil Affairs Brigade is brand-new (activated 16 SEP 2011), which means my battalion (based in Ft. Stewart, GA) is brand new--as in, the stand-up date is SEP 2012. So I'll be coming into a brand-new position, which is kinda cool and really scary. Cool because I get to drive what my position is, scary because I have to drive what my position is. The whole, "Am I really smart/talented enough for this?" question that will, I hope, be answered soon (and answered to the positive).

Little bit of background as to the brigade and battalion. The 85th CA Brigade was stood up because the Army realized it needed more civil affairs assets, and decided to put that in the active component, instead of the reserves, where most of the other CA assets are (nine reserve CA brigades and one active duty to support special operations existed previously). There are 5 battalions in the new brigade: the 81st is at Ft. Hood (activated in 2011); 82nd at Ft. Stewart, one (forget the number) at Ft. Bragg, to be activated in September; and one at Ft. Lewis and one at Ft. Bliss to come in 2013. Each of the battalions takes a different part of the globe, with the 82nd taking Africa. The only other part of the world I think would be more interesting to go (in terms of health needs and diseases) would be the Pacific, and that's going to belong to Ft. Lewis, once that battalion exists. I've started convincing my friend Raul, who will be graduating next year, that that's the job he wants.

As far as what I'll be doing, here's the official guidance in the field manual for Preventive Medicine Services (Field Manual 4-02.17, in case you were wondering):

3-14. Civil Affairs Units
In CA units, assigned PVNTMED personnel assess the public health capabilities of a country or area, but
are not responsible for directly providing PVNTMED services to them. As such, PVNTMED personnel
are assigned to CA companies, detachments, brigades, and commands. The type and number of PVNTMED
personnel assigned is dependent upon the unit. Since the staff's role is advisory, it has no organic
equipment and must coordinate for support from PVNTMED detachments and the AO supporting medical
laboratory. If available, CA units are also supported by PVNTMED detachments.

That's what I'll be doing when I'm in the field, but in the meantime, I'm still waiting for my official orders to appear and trying to figure out what training I need to do before September, but I am excited about it. 

Training Day

Today I got another reminder of why military interns/residents make more money than our civilian counterparts: training, or more specifically, training day. Not pleasant.

Since we have all sorts of mandatory training, about once a quarter, they put together a training day, providing multiple lectures for the in-person training we have to do, and lists of the electronic training. And for some reason, these always happen when I'm on in-patient wards or at Navy.

I started back on Ward 75 (aka, hell) on Monday, and my first day of call is tomorrow. Since we're the day pre-call, we have a pretty light census (we only admit on days when the team is on call), which I thought would translate into a little bit more sleep, but when I opened the email last night informing us of training day, I knew that wouldn't be the case. The first presentation was Alcohol and Substance Abuse Prevention (ASAP) at 0600--required annually, by fiscal years. Then I ran back up to the seventh floor from the second (that's more flights of stairs than it sounds; we have half-floors, but that's another story for another time), to get vitals and lab results on my patients and start rounding. Then at 0900 was Equal Opportunity/Prevention of Sexual Harassment (EO/POSH) (required quarterly, for some stupid reason) back on the second floor, and then back up to the seventh to write my notes and try to get work done. And then 1000 was Patient Safety (annually, and pretty much just consists of people talking about what kinds of mistakes interns make when writing orders), then back up to Ward 75 to finish work and prepare to sign out to the on-call team. There was also Warrior Proficiency Tasks (or something along those lines), which is required annually for everyone captain and below, from 1300-1700, but I skipped that. It's cold and raining, and I wasn't in the mood to practice dissembling/reassembling weapons or practicing litter carries or any of that. They'll tag me for that later in the year, I'm sure, even though I just did all of that at C4.

I also spent a good deal of time in the last couple of days doing online training to prepare to go to Peru for my research rotation in February. I've done Antiterrorism and Survival, Evasion, Resistance, and Escape (SERE), neither of which can really be taught online, realistically. Really, do they think answering a few questions about being held captive is going to help if it happens (especially since medical personnel can't technically be held captive, according to the Geneva Conventions)? Government efficiency, I guess.

And tomorrow, the first of five calls for the month...

4 star coins and the light at the end of the tunnel

For those of you who read my Facebook status update, you know that I now have coin from a four star general. Here it is:

And now story time. There is a lieutenant colonel in the room across from the MICU workstation. He was hit by an IED in Afghanistan (I believe... he's a SICU patient, so I don't know much about him). It's pretty rare that someone that highly ranked gets himself blown up (he was a Ranger or Special Forces or something), so he's gotten quite a lot of attention. I have now seen the Secretary of the Army and more stars than I can count. Anyway, on Monday morning, I was writing down lab values on my patients, and when I looked up from my computer, I saw stars. A line of four of them, right down the front of this man's uniform. He thanked us for all that we're doing to care for all of our patients, and then gave us coins.

As far as the light at the end of the tunnel, I had lunch yesterday with my future residency director, just to check in and see how my first month of internship is going and give me more information about the residency. Let's just say that I was really excited about what is to come. It really was a nice reminder that all of this being on call every third night and rounding for six hours thing doesn't go on forever.

I can't wait for next year.

Navy In-processing

It's been twelve days of in-processing and orientation, and today I got to take all that fun to National Naval Medical Center--NNMC, better known as Bethesda. Yeah, not so much fun.

Actually, the day started back at Walter Reed, where I got my official Department of the Army (DA) photo taken (haven't seen how it turned out yet), followed by a visit to the official computer people to inform them that I have been using Essentris (the in-patient computer system) for the last two years and therefore don't need to be trained on it. Fortunately, they agreed, gave me my new log-in and password, and sent me on my way, right over to the library so I can do my HIPAA training (yeah, definitely not fun). And then I went home, changed out of my class A uniform (greens, which I wore for the DA photo), back into my ACU's, and then got on the Metro and headed over to NNMC.

There, I picked up my in-processing packet in building 8, deck 2 (2nd floor; they don't realize that their hospital isn't a ship); then it was over to building 2, deck 1 to get my NNMC ID and parking pass, over to building 10, deck 2 to get put into the computer system, then building 1, deck 5 to do all sorts of computer training, including over an hour of 'command training' on the computer. Fortunately, the computer modules give you the option of taking the test without going through the slides, which probably saved three or four hours. Finally, I finished all of that "incredibly useful training", and headed back to building 8, deck 2, where they declared me in-processed. Then I went back home and have been fairly lazy since.

PT test

We had a height/weight check and diagnostic (meaning it doesn't count) PT test today as part of in-processing. I was measured at 64.75 inches (two inches taller than I am in real life), which meant that I was within Army standards on weight, and didn't have to be taped (specific measurements used to calculate body fat). That was the first time I didn't have to be taped, so I was pretty happy. Apparently, they did that with quite a few people, because I was talking to some other girls who usually have to be taped and didn't have to this time.

It is rather unfortunate that the PT test is just a diagnostic, because I ended up scoring 297/300 (it would have been a 310/300 if they used the extended scale). The PT test is two minutes of pushups, two minutes of situps, and a two-mile run, and is scored on a scale that goes up to 100 in each category. For women my age (22-26), 100 points is 46 pushups, 80 situps, and 15:36 on the run. I did 44 pushups (97 points), 81 situps (I forgot to stop after 80; 101 points on the extended scale), and ran two miles in 14:20 (112 points on the extended scale). I was really surprised with the run, because I've never ran two miles that quickly. I was the second fastest female, which was pretty exciting for me. Afterwards, a number of girls asked if they could go running with me, so they can prepare for the real PT test in October. So now I just need to keep up with my current level of fitness (well, exceed it on the pushups) to get a perfect score on the real PT test in October.

After that, we had to quickly (very quickly) shower and change into our ACU's for a 0930 formation (although our company commander didn't show up until 1000, which made us mad that we rushed through getting ready and didn't grab anything to eat in order to show up on time). Then it was two hours of suicide prevention lectures (fun, fun, and not really all that applicable to people who have graduated from medical school--after psych lectures and psych rotations, there was nothing there we hadn't already had drilled into our heads), and then I ran over to the commissary to get gas (much cheaper than off-post) and do a little bit of grocery shopping before heading home, where I'm currently sitting around in half a uniform (ACU pants and my undershirt), because I'm too lazy to completely change. I think I'll take a nap soon. We have a social activity tonight in Bethesda (yay to social events I can take the Metro to...), and I want to be well-rested for that.

Being in-processed to death

So yesterday and today I... did more in-processing. It's a little insane.

Yesterday we had our Class A (green service uniform) uniform inspections, to make sure we're all squared away for our DA (Department of the Army) pictures next week. So we show up, get our TB skin tests placed (no, that doesn't have anything to do with uniforms, but it happened), and sat around with rulers and uniform guides making sure things were straight and properly aligned to the buttons and seams. Then, we all stood in company formation (that was entertaining, getting 65 or so interns into a company formation) at attention while a first sergeant and three lesser-ranked sergeants walked up and down the ranks with their own rulers and making adjustments. It was all sorts of fun. Then we changed back into our ACU's (Army Combat Uniform; camouflage) and went back to the auditorium to be in-processed some more.

Today it was more of the same (only without the uniform inspection). There's an all-morning mandatory training for everyone in-processing into Walter Reed, regardless of rank or position, so that's where we were. They were pulling us out four at a time to meet with personnel about making sure we had all the proper documentation to calculate time in rank (pretty easy for me; captain with zero years in rank. Other people, those who had service before med school, were quite a bit more complicated). Then a few of us snuck out (after going over the Army's regulations on HIV in great detail while at Madigan, I didn't need the dumbed-down lecture about) and got our new CACs (Common Access Card; combination Army ID and key to computer systems). I like the picture on my old one better, but I'd rather have the rank of my new one :)

I actually got to take off early today (around 12:30), because the class was scheduled for BLS (Basic Life Support? I have no idea; we just call it BLS. It's pretty much just CPR). Anyway, I'm current on that, so I didn't have to stay (yay). No such luck tomorrow, though; it's ACLS (Advanced Cardiovascular Life Support), which expired two months ago. I'm glad for the refresher though; I'll probably have to use it quite a bit in the ICU when I start there in July.

More moving, and more hurrying up to wait

Here are a few pictures from the moving process:

The box maze of the living room. I could have had the movers unpack them, but since I had no idea where anything should go, I figured I should probably do it myself. Now, everything's been unpacked, and I haven't noticed anything broken or missing yet, so I'm happy.

A bunch of junk that had gone in my car. I somehow managed to fit 400 pounds of stuff in my car. I'm kinda proud of myself.

Anyway, onto other things. I'm now two days into in-processing/orientation. Yesterday was a long and painful day of, guess what, hurrying up and waiting. The best part had to be when we were told to hurry back from lunch to return to the classroom for in-processing at 1245. By 1345, we were all very confused and wondering what we had missed, because nobody came in to tell us what was going on. Finally, our company commander (who is also a captain, which makes for a frustrating situation, for both her and us) arrived to say that they heard forty-five minutes before that parking was running late. We were all rather upset that nobody had the common courtesy to tell us that before we sat around doing nothing for an extra hour.

And to make matters even more fun... We had to come in today to meet with finance. Well, finance finally showed up half an hour late, and then proceeded to run through a checklist of documents we would need for when we meet with finance again on Monday. Finally, one of my fellow interns raised his hand and told her that we already went through that sheet yesterday, and we all brought the proper documentation and were ready to fill out our forms. And of course, they weren't ready for us to be ready. So, in other words, we had to come in a Saturday for nothing. We were all happy about that.

We do get a day off tomorrow (yay...), but then have to report at 0500 on Monday. We're pretty sure that means that we're going to have a "surprise" drug test, because nothing else happens at 0500.

Didactics and free food

Not much exciting has been going on the last few days (hence the lack of posts), and not much happened today, but I felt the need to update, so this is what you get. We started the day with didactics and a quiz (which was, fortunately, fairly easy), rounding out the morning with 'geropardy' (Jeopardy questions about old people... my team lost because we liked to bet it all on daily doubles).

Anyway, I ducked out of class a bit early at 11:30 to head over to Meiling Hall, where I spent way too much time my first two years of medical school, to hear MAJ DeZee, an OSU College of Medicine alum and current internal medicine residency program director at William Beaumont Army Medical Center in El Paso, TX give a talk about humanitarian missions with the Army. I've actually heard him give this exact same speech before, during my first year. I also met with him at the American College of Physicians conference during my second year, so he was rather disappointed when I told him I decided to go into preventive medicine instead of internal medicine. I'll probably get to see him around Walter Reed next year, though, as he's taking over as the General Internal Medicine fellowship director at WRAMC. I hope that I'm working with him during one of my internal medicine ward months. He would be a really fun attending to have.

Between the lunch and the 'networking' (which was really just the Army students standing around and catching up), it was about 2pm when I first arrived at Dodd for my rotation. Apparently the attending didn't believe the residents when they told her that we were at didactics all morning and that I had a lunch, because she was grilling me what I was doing and why I hadn't seen my patients yet. Whatever. I just have to pass this rotation in order to graduate.

And now I'm tired, so I'm going to bed so I can get up early tomorrow and go to a case conference about testing sacral nerves. I'll give you a hint: it's not a test I would like done.

Medical board

My first (and only) patient of the day was already in when I arrived at clinic from morning report, getting his skin tests. He was a bit unusual in that he wasn't a new patient; he had been seen by COL Yang about a year and a half ago, before he was deployed to Iraq. At that point, he was being evaluated for his deployability, due to his history of allergies diagnosed and treated by a civilian allergist since he was a teenager. Needless to say, COL Yang determined him deployable (ie, his allergies wouldn't be enough of a problem to prevent him from doing his job in Iraq).

Well, unfortunately for the patient, he got in a motorcycle accident while he was on R&R nine months into his deployment, landing him in the hospital and rehab back in Hawaii. He messed up his shoulder during the accident, and there wasn't much a motor transport operator (88M for those of you familiar with Army MOS) could do, so he's been spending most of the last year on a medical profile. When it became obvious that he wouldn't be able to do his job again, he was referred to the medical board for a medical discharge. One thing that happens on medical board is they go through your medical record (obviously) and go over everything they've seen a specialist for. So, he had to go back to COL Yang to be evaluated for his allergies again. Guess what? We discovered he still has allergies (surprise, surprise). So we refilled his prescriptions, recommended he get hypoallergenic mattress covers and pillows, and determined that while he does have allergies, it wouldn't prevent him from retention (staying in the Army), which gave him a 10% disability with the VA (from what I figure, that means they have a condition that requires specialty care, but doesn't really cause disability). Conditions are summative; if someone has five conditions that each cause 10% disability, he is considered to be 50% disabled. In the case of this patient, his shoulder/back injury from the motorcycle gives him more than enough to get his medical discharge and to get full medical care from military facilities for life.

So, my one case today was yet another example of government red tape--a man who quite obviously can't do his job requiring him to lift 200+ pounds of equipment being evaluated for the dust mite allergy that causes him to sneeze.

Both a doctor and a soldier

As Army physicians (and future Army physicians), we know that our daily lives force us serve two--or more--masters, but never had I had such a good demonstration of this as today during a rather unusual noon conference--COL Salerno, the Internal Medicine Residency Director, giving his farewell address before deployment tomorrow.

An Army doctor, even a colonel, being deployed is not an unusual event, but his story is a little different, because he is a residency director. In 2005, the Army and the ACGME (American Council of Graduate Medical Education) formed a written agreement allowing residency directors to deploy for no longer than 90 days. This was a concession on the part of the ACGME, as previously residency directors could not deploy, due to accrediting regulations that require residency directors to be on-site, supervising their residents.

That being said, COL Salerno is not going to be gone for 90 days--he'll be gone for 10 months. After several "deployment scares" that prevented him from joining various committees that would be good for his career, he decided to volunteer for deployment, to get the waiting and wondering over with. Instead of taking a simple 90 day deployment working at a CSH (Combat Support Hospital), he volunteered for a position as an administrator of an Army-Iraqi medical team (he kinda explained, but I didn't really follow). He was going to split the deployment with another colonel, which would allow him to be gone for his 90 days and return to Tripler. He had written promises from a brigadier general and the other colonel that he would only be deployed for 90 days, to avoid any problems with the ACGME. However, as things have a tendency to do with the government, it fell through. After scrambling for two months trying to rectify the situation and applying for exemptions with the ACGME, nothing changed. Since 10 months is obviously a violation of the 90 day rule, he had to officially step down as Internal Medicine Residency Director at Tripler, which was not in the career plan he had set for himself.

However, things did work out for him. When he returns from deployment in August, he'll take over as the Director of Medical Education at Madigan. I was a little sad to hear about this, which had nothing to do with COL Salerno. LTC Wiesen, the Preventive Medicine Residency Director at Madigan, was applying for that position, which would have caused a shuffle in the preventive medicine residency programs beneficial for LTC Littell and MAJ Soltis, two staff members I enjoyed working with at Madigan and WRAIR, respectively. However, COL Salerno does outrank LTC Wiesen, so it's not too surprising.

Medical education positions aren't always easy to come by in either the civilian or military worlds, but rarely do civilian physicians have to worry about what will happen if their 90 day vacation to a war zone gets extended.

"Actually, that's 'thanks for the cake, sir.'"

Okay, so nobody's ever said that, but that's how I feel sometimes when I forget that in the Army, you're supposed to attach "sir" and "ma'am" to the end of everything when you're talking to a superior officer. It's not as if I was familiar enough with my attendings at OSU to call them by their first name, but I didn't end a conversation by saying, "I'll keep that in mind, sir," either. Often I realize about two minutes after LTC Littell or LTC Wiesen walks away that I should have done that, at which point it's obviously too late. CPT Peik seems good about remembering that (which is probably why I keep realizing that I forget it; I keep hearing him say it), but CPT Wilson doesn't seem to say his sirs and ma'ams all that regularly, either, so maybe I'm not as insubordinate as I sometimes think I am.

Anyway, proper address of senior physicians aside, today was a fairly normal day around PM at Madigan. The morning was spent going through AR 600-110, which is the Army Regulation on HIV testing and surveillance. Quite a lot of legalese and government-speak in there without ever really saying anything, which by the end of the morning made me feel like my head was going to explode. Then we had an award-giving ceremony for COL Barraza, the PM department chief, who is going to be leaving Madigan for Germany in a couple of weeks. There was cake, which was where the title of this post came from.

The afternoon was one long education session for me. The residents take turns going over chapters of the epidemiology textbook with me, and today they caught me for two chapters (they had been slacking, and realized that the week was almost over, so they had to get caught up on their educating responsibilities). I also did some work on my scoliosis project, which is currently looking longer than anticipated. Well, it's always easier to remove slides than put them in, so I'm not too worried about that.

After work was another not-so-fun aspect to being on a very, very large Army post. Today the power went out on Ft. Lewis everywhere except the Madigan Annex (I don't know why; we don't have a generator). This meant that all the streetlights were out, which made driving around a post with a couple thousand other people quite the experience. I was headed up to Uniform and Supply to buy more tee-shirts for under my ACU's, which requiring driving across post, only to be told that they were closed due to the power outages. So what would have normally been a twenty minute diversion on the way home turned into an extra hour and a half--and I had nothing to show for it. Such is life, I guess.

Playing Army

Today I took a brief break from practicing procedures on cadavers and played Army for a couple of hours. After putting a chest tube and interosseous line (like an IV, but directly into the bone) into someone who really isn't going to benefit from either, I changed out of my scrubs and into dress clothes to meet with Major General Bostick, the Commanding General of the US Army Recruiting Command, and his entire entourage. I, along with Dr. Hitchcock, the Military Medicine Interest Group advisor and retired Air Force major, showed them around the medical center and all the cool things we have there. In the process, I got coins.

The one on the left is from MG Bostick, the one on the right is from LTC Rice, the commanding officer of the 3rd Medical Recruiting Battalion. And the backs:

After the tour, I ran home to change into my class B uniform (green skirt, green short sleeved shirt with 2LT bars on the shoulders) and headed for the restaurant to socialize with people with much higher ranks than my own. Fortunately, there were a couple of dental students there, too, so I wasn't alone in my second lieutenant-ness. After that, it was running home again, changing back into my scrubs, and heading back to school to do a kidney biopsy on someone with much larger issues than that (another cadaver). All of the running around made me a bit tired, but they're paying for my education, so it's the least I could do. Besides, it got me coins :)