Reader Q: Why Did You Sign with the Army?

Hi Dr. SW101,

Enjoyed reading some of your blog posts both older and the newer army related ones today. Lots of smiles and chuckles, Thanks.

Laughter? In response to this blog? That’s TERRIBLE. This was supposed to be serious stuff. Like taxes. This is information. Data. Recommend re-read.

I’m curious to know why you signed up?

I signed up for the Army for one major reason and one minor reason.

The major reason was the craven want of money. I wish it was something more patriotic, but the primary motivation was an offer of a loan repayment grant and monthly stipend during my years in residency. The Army required nothing in return during my training years. Faced with sneaking my 6-member family into a 2-bd apartment that allows only 4 people, I took the money. Instead of the apartment, I was able to put my family in a cute 3-bd home on a quiet corner two blocks away from my training hospital.

The second reason was patriotic. Despite my vehement opposition to the war in Iraq, and moderate opposition to the war in Afghanastan, I was fully aware that primary care was severely lacking in the U.S. Army at a time when young Americans were throwing themselves into war. Irrespective of how I felt about those conflicts, I remain an American. News of my countrymen dying or suffering partially due to lack of good medical care was something I couldn’t tolerate.

I have always been taken with depictions of how our nation pulled together and sacrificed during the second world war. Back then, those war efforts were truly a national affair. Virtually everyone gave to the effort in some fashion. And, I think a huge reason for the wealth and power we have enjoyed for the past 60 years are a direct result of those sacrifices made by our Greatest Generation.

Pretty Sure I Woulda Deserted

“Earn this,” CPT John Miller, dying from a mortal wound during the Battle of Ramelle, implored Private Ryan in the Spielberg movie. The message, as I took it, was our generation (and the Boomers before us) must understand that great sacrifices were made to allow us to live on the top of the world as we have as Americans. It remains our mandate to earn that sacrifice; it was made before we even deserved it.

So I signed.

I saw posts about officer training and an earlier one about trying to figure out the military scheme as a civilian. What got you in? 

I think you’re referring to how I got into the Army as a civilian. If so, the answer is website: http://www.usajobs.com. Everything runs through this site. I applied to this site in the winter of my senior year of residency, and forgot about it. Literally. When I was called by the clinic here in Germany for an interview in MARCH the following year, I had no idea why.
If you want to get a job overseas, however, this is one of THE best routes. You can’t work for the State Dept as a doctor until you’ve been in practice out of residency for 5 years. You can’t get a job with any of the aid organizations unless you know someone AND don’t need money. So, this is a good option because the pay is steady, only slightly beneath the national average, and comes with perks that don’t usually accompany private-sector jobs.
There’s lots of archane goofiness that come with Army medicine. There’s lots of unusual quirks that are a result of non-medical “commanders” decreeing all kinds of demands from on-high.
But, in reality, every managed care organization functions like this these days. I wouldn’t put Army medicine behind or beneath any of the major HMO’s (in principle, I haven’t worked with any of them). I think Army Med is about on-par with most of American medicine…approximately 18th best in the world.
Also wondering why Olympia was your first choice? You’ve said elsewhere that Ventura is probably the best FM program in the US. I’ve heard of a number of graduates going to Tacoma Family Medicine and lots of interest in Alaska, too. Can you comment on them?
I am very proud of my FP training program, and maintain the belief that it is one of the best programs on Earth, and THE best on all outlying planets. I firmly believe that Providence is one greatest healthcare organizations anywhere.
But in all honesty, I have to say that Olympia is not the best. Just MY best.
English: Statue of Father Junípero Serra. Vent...
Father Ventura, surely a surfer
Ventura is better. Better than anywhere else I know of (and I practically got a PhD in FP residency research during med school). The hands-on experience they allow there, assuming times haven’t changed, is second to none. The faculty are top-notch; some are dual-certified, etc. Facilities suck, too, which is great. I can think of no better means of preparing an FP to deal with a crappy, under-funded, under-supplied environment where the only thing you have to give to patients is your training.
I was told I had a shot there. What they told me likely sounded MUCH like what they tell EVERY short-white coat wearing minion worshipping at the altar of VCMC during their exit interview. But I still like believing I coulda made it in there. I never ranked them, however, because my large family would have needed to live in a box on the beach to afford the cost of living in Ventura. And, truth be told, since I could have reasonably placed that box at the point at Fairgrounds (read: KILLER surf spot), residency would have been AWESOME for me. Just not for my kids waking up with sand fleas in their eyes and facing yet another breakfast of seaweed and/or Wonderbread bologna plus peanut butter sandwiches at the local Rescue Mission.
One nuance Ventura is the dual FP/MPH program at Dartmouth which is as good as it gets if policy and health system design is your calling. Love it or hate it, the Obama Health Care plan wisely referred to the health resources utility research out of Dartmouth. Although barely ranked, I am of the opinion that Dartmouth is actually one of the best – if not THE best – MPH program in the country because the research and work they do is prescient, unassailable, repeatable, tested and longstanding.
Tacoma is a great program, but they have nothing on Olympia. Their city smells weird, their facilities aren’t any better than ours, and we do rotations at the Peds ER up there anyway. So I recommend ranking them 1/2 with the top choice going to the town you like best.
Alaska is probably a lot like Ventura. Sans wicked right point-break and unfortunate box.
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Smarching

Sprinkler03
Me, spinning in formation

“1st Platoon!  Atten-SHUN!”

We all throw our shoulders back and stare straight ahead into nothing.  And we don’t move.  Leaders mill about, thinking about things, looking over their retirement accounts, playing Tetris on their phones. 

But we, the little people, just stand there.  Sweating.  Sweat runs in what feels like lightning patterns down my face.  Down my neck.  My back.  My rear…and down my legs.  I stand there taking a sweat-shower.  Spin me around fast enough and I’d fling so much water in every direction I think I could personally ease the drought problem in Texas.

“SMAAAARCH!”

Well, he actually say ‘march,’ but, really, you just can’t call it that.  No nuance.  We aren’t marching.  We’re walking around in 104 degree F heat, with sweat pouring from our bodies on par with your average Bangladeshi monsoon.  So we’re sweating.  With a little marching thrown in. 

It’s smarching.

RATIONal!

Yes, throwing a few words out there again.  Can’t help m’self.  Been a bit.

Living in Europe insulates the average human from goofy, over-the-top language meant to get people to do and think in ways that OTHER people want them to.  So, I haven’t been very caught up in, or all that impressed by, all the politics and steamy language coming out of my home country these past months.

Demilitarized Zone, North Korea
We have fast government. No arguing. You like. Like pizza.

Now the election is finally over, we find that Republicans have “swept” themselves into a level of “power” that assures exactly zero will happen unless they work with all the Democrats and Independents that never lost their jobs.  Some people think all the upcoming wrangling is a bad thing; I think it’s great.  A super-active government rarely doesn’t do anything well.  There IS a type of government that “gets things done” almost immediately, with little debate.  It’s called a dictatorship.  If you’re smitten with that idea, move to North Korea and try THAT speedy idea on and see how you like it.

Anyway, I received a link to a very persuasive and scary speech given by an orthopedic surgeon named Dr. David Janda, wherein he outlined the horrors and sneaky tricks piled into the Obama health care bill.  His speech was in support of Rob Steele, a cardiologist-turned-politician likely because he was mad as hell at the terrible direction of the country (*yawn*, aren’t we all?).  Presumably, said cardiologist is now back in the clinic, since he thoroughly

Republican Party Handbill, ca. 1880
Image by Cornell University Library via Flickr

lost the election of the 15th Congressional District of Michigan to John Dingell something like 83k votes to 118k votes.  Apparently, the Dingells have run that district for generations.  If you’re looking for nutty, inflammatory, manipulative language, look no further than at a political battle between a challenger losing in the polls as s/he tries to unseat a longstanding incumbent.

The gist of Dr. Janda’s speech is how Obama intends to RATION health care.  This actually sparked my interest.  I don’t really care about health care system politics; I’d rather just see patients, frankly.  But I have to just say to my fledgling SW101 crowd, I SUPPORT RATIONING.  Of every public resource.  Food. Gas. Sex (um, although I’d readily opt out of the “public” option).

New Orleans, Louisiana, 1943. Line at Rationin...
The whole idea of capitalism is so you don't have to share. Sharing sucks.

So many people take the idea of rationing to be unequivocally bad…as if it’s totally wrong and even beyond debate.  That’s the tack of Dr. Janda.  It’s something we all KNOW is wrong.  Like sticking needles in the eyes of baby squirrels or stomping on halloween pumpkins.

Incidentally, Janda is a specialist, supporting another specialist.  Primary care docs like me aren’t especially pleased with how specialists have garnered power and money for themselves in the AMS (Am. Med. System).  In particular, I’m speaking of orthopedic surgeons and cardiologists.  Specialists make fabulous money by ordering tests and procedures, none of which have ever been regulated or rationed in any way.  Echo’s and caths pay for the boat, private school and vacations to S. Pacific islands nobody can name.  Don’t tell me the only force driving clinical decisions is scientific evidence and standards of clinical care…money is money.  But even so, I’m for rationing.

President Barack Obama speaks to a joint sessi...
Hey friends! Here's a really mediocre idea!!

Let me say that I’m not happy about Obamacare. It was said well @ a recent conference, “who’s going to do a better job coming up with a fair, affordable national health care plan, 189 laywers in a room for half a year, or 10 family doctors in a room for a week? Obama went with the lawyers, he should have gone with the docs.”

That said, I FULLY AND COMPLETELY agree with rationing because it’s a necessity. In training, I followed a patient in the ICU who was costing close to 1 million dollars a day of PUBLIC MONEY for the last 4 months of her life. Somebody, somewhere needed to compassionately deny further intensive care to this woman, instead providing dignified hospice end-of-life management. Her case justified ONLY taxpayer-funded hospice care but nobody had the cajones to tell her that.

Every precious resource, if pooled for the common good, needs to be rationed. It’s where we get the term ‘rational’ and there’s a reason for it. Closer to home, my sister apparently has a University doctor telling her that she needs a thousand dollar procedure (colonoscopy). The procedure is not done by this doc’s specialty, and my sister hasn’t even had a rudimentary work-up to justify the cost of the scope.  She has not had a professional analyze of the risks vs. the benefits of doing it, either.  Yet she’s already being told that she needs this procedure.

Remember…EVERY test and procedure has significant risk associated with it. Wouldn’t it be nice to know that the doc my sis sees for a scope is a specialist? And, since that specialist pays for the Benz and sailboat from scope income, wouldn’t it be nice to know that he moved in a stepwise fashion through the GI workup process, a process that is peer-reviewed and widely accepted as essential before a scope is ordered?  This is the ‘rationing’ process that Obamacare advocates.  It puts serious limits on specialists in the provision of their care when it comes to big-ticket stuff like scopes, imaging and surgery.

But remember, we’re talking about rules in effect ONLY if you intend to get your neighbor to pay for your health care. YOU are welcome to pay for your own scope any time you wish. YOU can fund your own health insurance – one that doesn’t make docs do ANYTHING before they dig into your body – if you want.  I watched it work this way in Israel, and it was a pretty good deal.

However, the fact is most Americans believe they are SO important that they have the right to be treated like kings…paid for by peasants. But ethically, Americans have no right to whatever care they want whenever they want it, if they also expect someone else to pay for it.

Hugh Owen Thomas (1834-1891), British orthoped...
Trust me, I'm a DOCTOR! We ALL are.

The AMS does too many procedures and tests. The result of both is astronomical costs and HARM TO PATIENTS (through false-positive test results and procedure errors). So, not only is care rationing ethical and less costly, it is absolutely safer for patients. Healthcare is NOT safe. There is a risk-benefit ratio that must be considered any time a patient comes in contact with the health care system. Waiting for non-urgent care (knee replacements) and rationing of tests and procedures is ethical, cheaper and flat-out safer.

Incidentally, I argued this point in a debate in med school…waay before Obamacare. I have seen nothing since that time to sway my opinion. In fact, training and practice have only solidified that opinion with real-world facts.

Obama didn’t make our health care system right, but he did make it better. The Tea Party idea of repealing the new law is lunacy. If they REALLY want a free-market system, they need to dispense with EMTALA laws which dictate that ER docs (and now other specialties too) are required to see any and every patient.  THIS IS UNIVERSAL HEALTH CARE!!  It’s just the most inefficient, ineffective and expensive system in the world. We do have a social healthcare system. We just need to make it rational…starting with sensible rationing of limited resources.

It’s Not Just Sex

A good approximation of how sex and intimacy is regarded by the U.S. Armed Forces can be summed up in the phrase I heard recently: “If you needed a wife…we’da issued you one.”

These days, the U.S. Army is perhaps the most chaste and constrained military organization on planet earth.  No drinking on duty, no sex, no pillaging, no cavorting…and go easy on the damn swear words.

Contrast this with the Russian Army, and German, which frequently serves beer with lunch; the harder stuff after dinner.  And numerous armies – no joke – provide prostitutes to their deployed troops.  Effectively, a little mini-platoon comprised of practitioners of the world’s oldest profession gets sent to war zones right along with the soldiers.  No doubt this idea  is regarded by these armies as a Godzillian leap up the ladder of human rights.  In the past, when victorious they just raped the women (and men) of their vanquished quarry.  At times, a veritable sexual bonanza was promised as the leading incentive to engage in vicious battle in the first place.

Members of the U.S. Armed Forces by contrast, seem expected to never have sex of any kind.  If sexual organs didn’t come already attached to the bodies of their troops, I’m rather certain the Army would have confiscated all tissue related to human reproduction – and especially the related pleasures of it – on the first day of basic training, relegating every appendage to iron storage boxes next to the gold bars in Fort Knox.  “You can have your clitoris back after your 20, soldier.  Until then, kill stuff.  And like it.”

I’m a happily-married, loyal-to-death-do-us-part, honest-to-a-fault type of husband who, with the perfectly understandable exceptions of Rachel McAdams and Jennifer Connely, can provide infinite assurances to his wife that she has minimal reason to fear infidelity (in kind, if she ever meets Johnny Depp in a smoky, sultry, bean-baggy, beatnik bar…she has my blessing).  That said, I think the “Hooker Platoon” is a great idea.  Presumably, said professionals are well-paid, in control of their lives, and free of drugs.  Like it or not, humans are sexual beings and they go about obtaining it in a myriad of ways.  Might as well make it safe, fair, protected and consensual, even if questionably moral.

But what about the ones who aren’t deployed?  Or the ones who, by choice, remain celibate as they await – with admirable fidelity – their dear lover back home?  What about the people who have returned from over a year’s deployment, waay beyond ready to re-start a healthy, loving sexual relationship with their spouses?

Unfortunately, many soldiers return from war zones with major emotional and physical damage – and major problems having sex.  PTSD, insomnia, chronic pain, depression and anxiety all affect sexual ability.  And these problems are like cockroaches…if you have one, you probably have others.  Worse, the meds used to treat the above problems often severely inhibit sexual function too.  Am I the only one who sees the Faustian irony in “You can be happy…OR you can have sex.  Not both.  Your choice.”  For many (including me), that choice is an oxymoron…emphasis on moron.

While not always the problem, erectile dysfunction is one of the more common issues I deal with.  Given the ubiquitous commercials displaying medically-enhanced virile men, one would think ED wouldn’t be such a problem.  And it is true…a pill can solve the problem sometimes.  Cool, right?  A nice, easy fix.  The problem is that sex is considered by the Army to be something of a sport.  Golf, but morally suspect and generally distrusted.  As if to clarify their position, one of the more odd policies I’ve seen is the meet-you-1/20th-of-the-way idea of providing 6 pills of Levitra per month for up to 3 months for erectile dysfunction.  6.  For 3 months.  Then…good luck.

But 6 pills?  A month?  I know they’re expensive – something like 10 bucks a pill – but who came up with a number like that?  Was he (or she…or it) ever in a loving, happy sexual relationship?  Had it already donated the entirety of its copulation gear to NORAD for weapons testing?  Turns out the decision comes from the Department of Defense.  Yep.  The guys buying fiber-plated bombers and infra-red rifle sights and inventing bombs that suck your inner organs out through your maxillary sinus, are also the ones who decided that 6 sexual encounters a month should keep the average couple happy.

Truth is, for many of my returning soldiers, sex and intimacy isn’t simply a nice addition to their lives after over a year of living in austerity.  It is life.  This seems to be especially true of the committed, married soldiers I work with.  Their marriage, and the love they share within it, is often the only salve on wounds that cover their bodies and souls.  Imagine falling into the yearning arms of your wife after 15 months alone, after encountering horrors on the battlefield you will never describe, only to have to say you’re sorry, you just aren’t the same as you were…even as a lover.

A patient recently said to me (to paraphrase), “My wife and I LOVE to have sex, doc.  It’s an every day thing, if not two or three times a day.  At least, that’s how it was.  Now we spend most of the time we would have spent in bed – or in the kitchen, or in the microwave, or in the neighbor’s tool shed, or on top of the dresser, or under the aquarium, or in the chimney, or dressed up as Tonto and the short curly-haired lady from Cheers – with a counselor, trying to figure out what’s wrong with me.”

Most (not all) healthy, vital, loving relationships are comprised of sex more than just once a week with an occasional “two-fer” on the weekend.  Especially if one of the partners has been gone for over a year.  If returning injured soldiers have anything to look forward to, for many of them it’s their longsuffering, waiting, pent-up, willing spouse.  Divorce is a catastrophe, especially when it’s between a broken soldier and the person who typically is the last one standing in their corner when the world is running down.  Seems to me that we could forgo a couple of those useless air-to-air combat fighters everyone’s arguing about and use the money to give these soldiers as many nights of intimate bliss as we possibly can.

Oh-NineHundred

Nothing makes an Army drill sargent (prounounced something like ‘Sar-Ughnt’) more testy than when a good number of his/her unit skips morning physical training.

I take that back…there’s a veritable Olympics of things competing to be the thing a drill sargent hates the most.  But showing up late for PT is definitely on the list.

One of my jobs is to set up patients with this Army thing called a Profile.  THE profile.  After a few months here, I can say in all certainty that the profile is my own personal battlefield.  Everything I do seems to revolve around this paean to administrative oversight.

Simply put, the profile defines what an injured soldier can and can’t do.  They get very specific: Soldier may mix cocktails, but d/t a herniated C-4 disk, he may not tip his head back to drink them.

Oh MAN...we can't come in 'till 9. Super tired...

One of the big reasons I see patients is to “review the profile.”  Read between the lines, and typically, the visit is really about the patient trying to get some other restriction put on their profile.  Restrictions that will make most soldiers ecstatic and drive a drill sargent nuts.

The most ubiquitous profile restriction is the “0900 work call”.  Prounounced “Oh-9 call”.

Droopy-eyed private: “Uh, man, sir, uh.  Need an Oh-9 profile.  TONS of sleep meds. Can’t get up for 0630 PT.  Help.  Desperate and all that.”

Me, Dr. Naive:  “Ok.”  Fill out form.

Private: “THANKS, man.  Can I get Oh-9 profiles for the rest of my X-Box buddies.  Now that I can stay up all night playing Soldier of Fortune, I need my buddies cuz we compete against each other.”

“Soldier of Fortune…isn’t that pretty bloody.”

Evil smile, “YEAH, totally.  We just run around shooting everybody.”

“K.  Why are you on meds again?”

“Can’t sleep.  PTSD.  Keep seeing people get shot when I close my eyes.”

Embellished only slightly, I’m coming to the point where I can’t see a SINGLE medical reason to approve someone for 0900 work call.  Sleep meds don’t last forever.  If you take them at 7pm and are in bed by 0800, you should be able to get up in time for PT.

I’m asking around to doctors I know:  Any medical reason you can think of to allow someone to come in at 0900 rather than 0630?

The Toilet Excuse? Really?

“I need more drugs because I had a heart attack yesterday and in my monumental pain I flushed my Percocet down the toilet.”

I stare.

 

AWwww, MAN, I don't know WHAT happened, man.

“No really.  I’m serious.  I don’t know what’s going on with my heart and I accidentally flushed my drugs down the toilet when it was causing me, like, serious pain.  I REALLY need some more.  I’m in like 24/10 pain.”

 

“That’s a pretty strange fraction.”

“Well, that’s how bad it is.”

I hope my eyes are at least a little more than half-closed, “Dude.  That’s your excuse?  Really?  That’s the best you have for me?  Flushed?”  My ever-blindingly cheerful mood deflates a bit.

“Well, it was the case manager who told me to come to you for more Percocet.  I tode her Dr. SW101 isn’t cool with narcs, so I figured you wouldn’t go for it, but she told me to try.”

“So, the NURSE made you do it?”

“No…well (looks hopefully at me), uh, maybe?”

 

Dr. SW101 set me UP!

He did utter one truth, I’m not cool with writing for unfathomable doses of highly-addictive, mind-altering substances that have outrageous street value and regularly cause the utter destruction of families, careers and lives.

 

He’s right.  I’m not cool with that.

Sometimes it feels like I’m just sitting in my clinic handing out bullets…each one stamped with “If this causes a disaster of any kind, please blame Dr. SW101.  His bank account number is 7749220485, and you can find his children at 13 XX street, usually after 6pm.  Punish him accordingly for making such a mockery of his Doctor’s Oath, society, God, the memory of Elvis, Stonehenge, Hello Kitty, Gooeyducks..and everything else even remotely sacred to humanity.”

But I’m used to that.  I’m used to being the candy man.  What I’m NOT used to, is being taken for so dimwitted that the medical equivalent of ‘the dog ate my homework’ excuse might work on me.

“You’re really using THAT one on me?”

“Look man,” (whips out his Blackberry Smartphone, provided free of charge by the Army to help with his healing), “I got pictures of the pills in the toilet.”

I decline the visual.  Don’t even need it.

“You’d need to pin my face to a cork-board with something in the range of 34,000 thumbtacks to talk me into giving you more narcotics with that lame excuse.”  I say.  What I DON’T say is that aside from fighting the good fight against blatant drug addicts (I do take care of true heroes; he’s not one of them), I’m just flat-out annoyed at the excuse.

“Frankly, you’re story is miserable.  Put in a little work, and you might score a few hits out of me for creativity.  I’ve been known to drop a few Vikes on someone just to tribute their impeccible style alone.”

“Style?”

“Yeah, you know, do some deep-thinking before you try get me to double your daily horse-halting, blue whale-euthanizing, brontosaurus-stupefying doses of addictive opiates.”

“Liiike, a better story?”

“Yep.  I loovvve fiction.”

“Um, like what?”

“The doc I’m replacing was partial to “I washed ’em in my uniform”, so I’d say that’s a little, uh faded haha no pun intended *aHEM*, sorry, not making light of your “pain” or whatever, just a little side-joke for this glorious Army morning.  Anyway, where was I?”

“You were helping me come up with a story to score more narcs out of you.”

“Oh YEAH.  Thanks!  Let’s see, maybe I can help you….next time, try something along the lines of:

 

They're real. Seriously.

After a valiant but ultimately tragic battle, a saber-tooth tiger ripped your friend’s head off.  In desperation, you heroically dispatched said wildcat with your bare hands (careful with the back).  Then, without pausing to consider yourself, you gave him your ENTIRE BOTTLE of pills strong enough to drive the entire population of Gambia into rehab.

 

Unfortunately, when he swallowed them – since his head was removed from his body – your pills just dropped out on the ground, all slimy and spit-covered and quickly dissolved.  Thinking fastly, you propped his body up and then held his head over what you figured was the esophagus part of  your life-long friend’s neck so the remaining few pills – “Damn you, Johnny, swallow! – dropped out and settled into one of his neck-tubes, hopefully not the trachea.  Then you got him to a local ER, where they skillfully re-attached his head.

ONLY THEN, after your friend was recovering (he just might pull through, snif), did you think of yourself, realizing that you were, in fact, out of drugs for your endless back pain and heart attacks which you’ve been suffering from since you were born, 20 years ago.”

That would work?”

“No.  But honestly, that story has more credibility than, ‘I flushed ’em, brah, gimme some more.”

Numb and Numb-er

I’m happy to announce that I now drive a Mercedes-Benz.  It’s true.  A real in-the-steel-and-glass Mercedes.  The model is a C-180, which is the 4-cylinder, 4-door model.  The smallest engine they make (great gas mileage).  To boot – it’s green, my favorite color.

I’m a doctor now, people.  Apparently helping sick people entitles me to the high-life.

Truth is, here in Germany, the term “hooptie” is a known, legitimate noun.  The term is used to describe nice German cars that are (usually) bought by Americans and then run into the ground.  You can pick up BMW and Mercedes hoopties for 500 euros.

 

merced
Mine looks just like this one...but way cooler.

My car isn’t exactly a hooptie.  In the States, it would probably have cost at least $5,000, maybe more.  I don’t really know because I’ve never been in the market for Mercedes-es.  But I got mine here for a few thousand bucks.  It’s still in good shape and as long as I take care of it (an expensive proposition in Germany), it should get me around for at least a few years.

That is…unless it takes a few years until my new monument to affluent living is allowed to take me anywhere.

Take the Army’s torrid and longstanding love affair with bureaucracy and combine it with 1000 years of rulership of the masses in Europe, you get the process I dealt with just to be allowed to drive a car.

Buying the car is easy.  But in this Germo-Americo Funkenthink, the quagmire starts there.  You first need a special driver’s license, which requires a half-day class and then a 130 question test ( which I immediately failed by about 15 questions).

You also have to have insurance on a car before you actually register it.  And, the car needs to be inspected.  But you can’t drive it to the inspector’s unless you have it registered and insured.  But if you fail the inspection, you’ve just registered and insured a car that sucks.  So, you have to de-register it (I did that – twice – before I settled on the Mercedes).  De-registering requires a trip to the local customs office (American) plus a second trip to the other customs office (German, 35 min drive), numerous forms, money, waiting and…all the while you still need the insurance.

So, I’ve been a little reticent to drive much unless I have to.  I’m always wondering if I actually have all the paperwork and proof that will allow me to stay out of jail were I to get pulled over.

Instead, I came up with an alternative (heh, heh):

Through some highly unfortunate events in my brother’s life, I ended up with his Harley motorcycle.  Now, make no mistake – I owe him for this very expensive bike.  It was a ‘take-care-of-my-hoss-for-awhile’  kind of proposition.  Of course, being a deeply loyal brother, I immediately agreed to “help out”.  But, not being a big Harley-lover, I…well, I sold it.  And I bought a BMW motorcycle instead.  Initially, I sold it to help fund out trip out here, and a portion of the Harley money was a HUGE help in getting us here.  That said, I GUESS whatever money we had left over should have been sent back to my saintly bro.  But with all these fantastic German road machines around, you sorta just get Beemer Fever.  What was I supposed to do?

And anyway, my bro is about 10,000 miles from me.  Is he really going to come get me when he realizes I sold his Harley?  I mean, c’mon, I did the guy a favor!  BMW vs. Harley is a no-brainer.

 

bmw
Mine's just a LITTLE less shiny and has panniers.

So I now fly along the German Autobahn on a R1150 RS BMW.  Riding a bike like that, in this part of the world (any part of the world if you worship BMW bikes) is an experience that is hard to replicate.  Harder to describe.  At 80 miles an hour, I blow by stunning autumn trees, taking in their blurred resplendence in shimmering hues of gold and yellow and red.  “My” bike purrs along effortlessly.  When I lean over the gas tank and duck behind the faring, the engine sounds something like a sewing machine, but even softer, maybe more like two feathers rubbing together.

There’s only one problem…Germany is COLD.  The other day I left for work in the dark, road sparkling with frost, at a temp of -2.5 Celsius.  Buh-rrr.  And this is only OCTOBER.

The night before, I had received a notification in the mail that my car did not have the correct license plates due to a dating error in the – you guessed it – insurance policy.  So, should I be pulled over in my esteemed Mercedes for any reason, I could expect to be hog-tied, whipped and sent back to the States crisply folded into a shoe box.

Thus, while my longsuffering wife dealt with the paper-pushers in Hiedelburg, I rode the bike to work, frost and chill notwithstanding.  I do have some decent riding gear I picked up when I first got the Harley.  I have a jacket with armor in the shoulders and arms, and pants with knee and hip pads.  I have big thick gloves – also a “gift” *ahem* from my bro – and good riding boots.  All the gear is made to withstand serious wind and rain.

 

jeff_daniels1
"Got a little nippy back there going through the pass, eh Har?"

But I’m not sure any gear will hold up for long when receiving a direct 80 MPH sub-freezing air blast for 40 straight minutes.  Mine didn’t.  By the time I got to work, I was so cold most of joints wouldn’t bend.  I walked into the clinic like I was in a body-cast.  I don’t think I even spoke to my first 3 patients that day because I couldn’t unclench my jaw.  I just nodded compassionately with my hands buried in my armpits and gave ’em whatever drugs they wanted.

I probably should have just sold the Harley and given whatever money we didn’t need back to my brother.  But instead I chose to buy a Beemer with the extra cash and freeze my face off in Germany.  If you love BMW motorcycles, you’ll understand completely.  You’ll probably applaud me for such a wise and intelligent idea.

I’m cheering, anyway.

Ode To Mr. Fingerprint

We can’t figure it out, exactly.  There isn’t one thing that we can point to and say, “Yeah!  That’s were everything became too much.”

But somewhere along the way, this little adventure piled up and reduced both of us to tears.  How the Army manages to organize itself enough to go around the world killing people – unless through excessive paperwork – still mystifies me.  But I can say that if they just stuck to the paperwork – threatened to attack the terrorists with administrative paperwork – world peace would be ho-hum news. 

“We give up!  We recant!  Never mind all that Allah stuff!  We’re Americans now.  Look, look, we’re buying Hummers and we all have flat-screen T.V. in our camel-skin tents with only CNN and Disney channels on them.”

I will say this:  With exception of the laudable fingerprint dude, I have never been to an Army office and gotten done what I came there to do on my first attempt.  Never.  And, for the guy to do my fingerprints that day, he had to overlook 2 reasons to send me away. 

If I’d had a trophy, I would have given it to him.  I DID sing his praises; describing his feat in a halting, emotional, too-grateful voice.

“I….I….I just want to let you know that.  *AHEM!*  Sorry, something in my throat.  Some sort of lump.  Anyway….”

Corpulent man in too-short square tie knit by kids in Taiwan R.O.C. funded by Wal-Mart stares dully, shifting slightly in his creaking office chair.

“You’re the first, EVER, to give me what I came to get on my very first attempt!  It’s a record.  Over the past 6 months, in dozens – maybe hundreds – of office visits my wife and I have needed to make just so I can do a job, you’re the first to not send me away on my first request.”

“Huh.  That’s good.  Fill out an I.C.E. card, alright?”

“What’s that?”

“A card.  You know, a card.  Tell ’em how I’m doin’.  Let ’em know I set you up.”

Right.  I.C.E. card.  I took that thing home, spent 45 minutes filling it up with love and gratitude toward the first man EVER to spare me making 2+ trips just to get a simple administrative task done.

Then I realized it would take another trip to that office to put the card in the guy’s box.

And I shredded the thing.

Moo, Baa, La La La

“What are you gonna do, Napoleon?”

“Whatever I want!  GOSH!”

That’s me.  Doing pretty much whatever I want.  The problem is, I’m not really sure how to handle this kind of freedom.  With apologies to Sandra Boynton, I figured a great title for this post would be in reference to creatures like cows and sheep, etc.

I’m used to residency.  Every moment of your life for those years is owned, every minute planned and directed.  Residency training brought out the cow in me, built it up and filled it out.  I’m good at being told where to go, when, how.

“Dr. SW101,” Someone asked yesterday.  “You are the team leader of 15 medical professionals overseeing a wide panel of injured soldiers.  How do you want to proceed?”

“Ohh, haha.  That’s easy.  Mooooooooooooooooobaaalalala!”

What Price, Integrity?

2000 Euro, apparently.

Through a housing allowance loophole, I could have almost certainly been approved for an extra 1000 Euro per month for the next 2 months.  The arrangement would have been a classic “kick-back” scenario between me and the owner of the house we’re buying.

However, in a last-second surge of some strange amalgamated emotion at least distantly related to those of guilt, honesty, obligation and craven fear, I killed the deal.

We are, in fact, buying this house, but will rent it for 2 months until the financing officially comes through.  During this time, my housing allowance will cover the rent – nothing more.

Quite honestly (since we’re on this honest kick), I feel sick about it.  I feel like I walked by $3,000 cash in a bush, and left it there.  I also feel it was the right thing to do.  But believe me, I had all the paperwork set up to take advantage of the oversight up until the final hour.

I should mention that the stakes are high right now.  The move to Europe is turning out to be much more stressful than I imagined.  This place is UNBELIEVABLY expensive.  I don’t understand how anyone can afford to even breathe out here.  I need to get my family out of debt…not go further into it by moving out here.

Let me quickly describe a government “housing allowance” as it pertains to me.  Termed the “LQA” or Living Quarters Allowance, anyone approved to live “off base” (most of us civilians are) is put on a scaled allowance.  You get more money for your status on the hiring scale (I’m waaay up there), and your number of “dependents” (pretty thin air on that one too).

So, when initially told of my housing allowance, I rejoiced!  I’m allowed thousands of dollars a month to spend on housing and utilities.  What a sweet deal!  In deciding if I could afford to take this job, I added my allowance ceiling (close to 50,000 per year!) into my yearly salary.

Keep in mind that my government pay as a doctor is very low in comparison to my private colleagues.  But when I added my LQA – viola! – my salary magically became competitive with the rest of the new-entry family docs in the country.

Then I arrive here to find that, essentially, it’s impossible to spend my LQA.  The arrangement is a “use it or lose it” kind of thing.  If you only spend half of your allowance, you can’t have the rest in cash.

The allowance, really, is a virtual amount that allows me to live pretty much wherever I want during the time that I’m here.  But even the nicest places in the area don’t rent for anywhere near what I’m approved for.  It’s like being told that you just won 1 BILLION DOLLARS!  Buuut, you can only use the money on M&M’s, and they can only be eaten, not sold.  Effectively, I’ve been given a lifetime supply of all-I-can-eat M&M’s.

I can’t have the cash, and, as you might imagine, I also can’t go to a landlord and say, “You’re charging 1100 euros a month for rent.  I’m approved for 3000.  How ’bout you and me split the difference every month?”  A housing office has to approve the rent amount based on an inspection of the house, and it won’t pay above that amount.

This thinking is classic for government, where everything is about sustenance.  Nobody is supposed to capitalize on government money.  You can only be sustained by it.  If you’re important, you can be sustained in really nice conditions.  If you’re not important – crappy conditions.  But either way, you aren’t to actually make money.  It’s unapologetic communism.

Getting kickbacks from your landlord is considered unethical.  And, effectively, this is what I had the ability to do for the two months until we buy our house.  As mentioned, I didn’t go that route.  I feel sick about it.  Not noble.  Not honest.  Not righteous.  NOT cool.  And pretty dumb.

Here’s a few reasons I pondered to justify the choice:

-The unethical thing is that doctors are paid so little in government work. They should have a program that either pays salaries commensurate with the private sector, or add an actual and functional loan repayment component to the salary (most current guv repayment programs are worthless – at best – and complete deception at their worst).  I really, truly, don’t care about money.  But the debt I carry sickens me.  I’m left to fend for myself on their paltry salary and a lifetime supply of M&M’s.

-I was deceived about the LQA.  Sure, it wasn’t deliberate…probably.  All the details and stipulations were simply left out.  But I came out here thinking my salary was 50k better than reality, when it’s really only about 15k.  Yeah, it’s cool to pick virtually any place I want to live.  But not really.  I’m chained to my debt.  And those chains are pretty heavy…too heavy to allow for much swimming in my rented pool in my rented German villa.  I need to make financial choices that will free me and my wide-eyed children from this financial prison.  The system should allow for that and it doesn’t.  I need to exploit loopholes wherever I find them.

-Also as a wealth-building strategy that I would HAPPILY forgo were I debt-free, we are choosing to buy this house. This puts added pressure on me to be happy in my job, and to stay in Europe for 5-10 years, rather than my stipulated 3.  If I want to leave, owning a house highly complicates my exit strategy.

-My mortgage is nearly $600/month more than the housing office has approved for the house in its current condition. So, if I want to rent the house to someone, I can only charge the max amount approved by the Housing Office.

However, the house has an extra bedroom that was not counted during the last inspection because it needs renovation.  We could pour 2000 extra Euro into renovating that bedroom and adding a bathroom next to it.  This would increase the allowed amount I can charge to a renter. I’ll bet the house would get approved to an amount very close to my mortgage with some good renovation.  Then, I can go to work every day in the freedom that if I get fired, or if funding for my slot dries up, or if I hate the job and want to go home…I can rent the house out without going broke (houses don’t sell well in Germany…sometimes sitting on the market for years, but the rental market is hot because of the military activity).

-I won’t get caught. People do this kind of thing all the time.

-I’m only using what I’m approved for. Not more.

-The Realtor did it. I didn’t think this up.

-Maybe it’s ok in my case, since the loophole doesn’t exist for most others (my rental contract doesn’t need approval from the housing office).

Reasons Against:

My Dad’s face in my mind: The guy works every day.  Supported me every day since he adopted me.  And pays taxes, every day.  He got behind on taxes once, and getting square with the IRS nearly killed him.  But he did it.  Little by little, he gave them every dime they demanded of him.  My housing allowance is paid for by guys like him.  I’m not ripping off millionaire Senators with health care for life…I’m ripping off honest, real Americans who believe that their taxes are being used appropriately.

-Professionalism: Frankly, many of my generation’s colleagues, myself included, hate this word.  What once was a sterling understanding between every member of my profession has become an strategically ill-defined mechanism for manipulation, money-making and power-plays by Boomer Gen on Gen X/Y.  Happens all the time in residency, but banks play the game, insurance companies, lawyers too.

Still, a fundamental element of professionalism is a high standard of honesty.  We say what we mean, we mean what we say, we stand by our word and play it straight.  Doctors regard trust as immutable currency in the most sacred component of our profession, the doctor-patient relationship.  This is the very fabric of our livelihood, and it all is built on trust.

-My training: Let me be discreet here in saying that during residency, I had a few moments where I was *ahem* mildly cavalier regarding my whereabouts on certain mornings.  This lackadaisical approach to the exact truth led to some harsh responses from those who oversaw me.  I got my ducks in a row pretty quickly.  Now, the stringently honest approach is the only one that feels right.

-Sleeping well: Also a lesson learned in residency: if you didn’t do anything wrong, you don’t have to worry about getting caught.  In the movie, “The Hunt for Red October”, a submarine captain prepares to fire torpedoes at an enemy ship…but first he puts a safety on them so that they can’t explode until they have been swimming around for awhile.  “I don’t want those fish comin’ back on us!”  He says.

For me, the same thing is true.  I don’t know – really – how closely they’re watching what I do.  Maybe this is a big problem right now.  Maybe they’re working on closing the loophole and will be auditing everything once they get the new policy in place.  Maybe, maybe, maybe.  I can go to sleep tonight not worrying about the maybes.  I played by the rules.  If something is messed up, I know it’s an honest mistake – that I’m not “busted”.  Makes for an easier thought life (allows me to wring my hands about foreclosure without any messy distractions).

So there you have it, folks.  The emotional undulations I’ve endured over this weekend, mulling the ethical conundrum over and over in my mind.  I feel sick about it.  Improving the house doesn’t just help our investment.  It gives me freedom in my job, freedom to enjoy Europe, freedom from worry.  The pill has been a bitter one.

My brother told me recently that now, as a doctor, I’m not really going to care about a few thousand bucks here and there.  Sure, I’ll be careful with my money, but a few grand won’t be something I’ll break my back for like I would have in the past.

I hope he’s right.  Because that 3000 bucks sure feels like a lot of money at the moment.  I’d work pretty hard for those extra thousands right now because of how much they could help us.  But apparently, I won’t lie for them.  One day, finally out of debt, I suppose I’ll look on this choice as a good one.

For now, I regret it….although I am looking forward to a good night’s sleep.