There is an unwritten rule in the Army: “If you think you have it bad, there is always someone somewhere that has it worse.” Usually, that person in the Army has a combat arms background (Infantry, Armor, Special Forces). Most of these volunteers love what they do and would have it no other way. It was and still is an honor to support them medically, and I have the utmost respect for these front-line fighters; they have earned it a hundred times over in the last 15 years. I certainly don’t mean to belittle them in the text that follows nor do I wish to make light of those who made the ultimate sacrifice in Iraq or those that came home with physical or mental wounds they will carry for the remainder of their lives. But I tend to see humor as a great defense or coping mechanism when dealing with stress and in doing so, believe it builds resilience .

There is a saying that war is 90 % boredom and 10 % sheer terror. I think those that closely served with me in a Combat Support Hospital during this deployment would agree that our ratio was closer to 70 % boredom, and 30 % humor, even during those brief times of terror secondary to mostly rocket or mortar attacks. Humor helped to cope with the boredom, frustration, and suffering and, in my opinion, was the glue that held us together as a team. This chapter will cover the weeks leading up to deployment into Iraq, from Fort Hood, Texas, to Camp Victory in Kuwait, to the four-day convoy to Balad, Iraq , about 40 miles North of Baghdad.

Looking back, the initial few months of the deployment was tough at times but not too difficult. More tests of hard times were in my future. However, my progression toward enlightenment on the point that “someone always had it worse” started at Darnell Army Community Hospital at Fort Hood, Texas. I was the Chief of Outpatient Psychiatry. It was an impressive sounding title, but I was the most junior officer on the department medical staff.

The work was slow, and uninteresting compared to my previous 2 years assigned as the Division Psychiatrist to the first Cavalry Division . Most of the soldiers that came into the outpatient clinic at Darnall during this time were related to morale issues or anxiety to the upcoming deployment.

There were a lot of soldiers transitioning through Fort Hood at the time since it was 2003, and we were going to Iraq. The Department Chief approached me in February 2003 and asked me if I wanted to volunteer to deploy with the 21st Combat Support Hospital (CSH ) . This unit would be built around a core of locally assigned medical staff, but would pull staff from military hospitals all around the country using the professional filler system, or PROFIS .

My wife was six months pregnant with our third child, which gave me some pause, but I selfishly jumped at the chance to deploy. And I will add that barring capture (death or injury never crossed my mind), I suspected my deployment would be easier for me than her staying home with a newborn and two toddlers ages 1 and 2 (I was right). My major reference point for what this deployment would look like was the short Gulf War in 1991 , and I figured it would not be more than 6 months. I had previously completed a training rotation with the unit I was assigned to with the First Cavalry Division at the National Training Center (NTC) . NTC is located at Fort Irwin, California, in the middle of the Mojave Desert. It was dry, hot and austere preparation for what we faced in Iraq.

I spent the 90s in a psychiatry internship , residency and fellowship; thus I was not permitted to deploy while in training status. My first assignment out of training was with the First Cavalry Division in 2000, and that unit did not deploy to Afghanistan. I expected Iraq might be my only opportunity to deploy, and I did not want to be that soldier who spent his entire career practicing for the big game but never getting in the game. I firmly believed that the USA would not be involved in either country for too long, and wanted to do my part in service.

The CSH did some training at Fort Hood, familiarizing ourselves with weapons, chemical/biological equipment, etc. I had qualified as an expert shot with the M16 rifle and M9 pistol with previous units, but I wasn’t assigned a weapon. At the time, Army policy stated that only 70 % of medical personnel were required to be armed when deployed. I wasn’t too upset, if it came down to doctors and nurses needing actually to fire at an enemy combatant, there would be plenty of weapons lying around. Additionally, I thought about accountability for that weapon 24/7. Not having a weapon in combat could end my life, but losing one could end my career. I gambled with the latter and took the same attitude in a future deployment. I would not make the same choice if I ever deploy again, but that decision is based on better training and familiarization I later received while serving in another unit.

We were warned that we would not have cots once we arrived in Kuwait , secondary to a change of plans in the overall unit deployment orders. All our equipment was to be routed through a particular country, and that changed unexpectedly at the last minute. These things happen and it was no fault of the command or supply (it helps to take this attitude, and better to laugh than get angry) so I purchased and duct taped a cot to the side of my duffle bag. There would be things crawling on the ground in the desert that would be attracted to my body heat.

My cot became an issue of both admiration and contention when we arrived in Kuwait. As advertised, there were no other sleeping options but the ground for the 76 other souls with whom I shared a tent. The extra space my bed occupied was resented by a few, but I’d always been a light sleeper, so I wasn’t about to give it up and face the constant barrage of coughing (or feet) in my face all through the night.

The coughing was an epidemic in Kuwait. The ever-present dust from the desert storms blasted into the tent, fouling both lungs and equipment, every time someone was foolish enough to open the door. Viruses also spread rampantly. Outside it was 110 °F, but overly enthusiastic air conditioners kept the temperatures inside at near freezing.

The cold ate at me at night. I had brought only a thin green sleeping bag rather than the winter black shell we were also issued. Back at Fort Hood, the thicker material had seemed an undue burden to carry to the scorching desert. After all, we weren’t even supposed to be there for the winter. It was going to be a short war, and my deployment orders ended in 179 days (I learned later that the Army could always change or extend orders). And it was much colder in the winter.

The solution to the frigid tent came in the form of a horse blanket bought from a local Kuwaiti . It smelled like a stable, but at least it was warm. In retrospect, I could have broken out the polypro long underwear that lurked at the bottom of my duffle bag. At the time, apathy was a stronger force than the cold.

My resolve was weakened not only by the sand and the extremes of temperature but also by the acclimatization illness . This came in the form of a cough, sore throat, fever, headache, dizziness, fatigue, joint pain, and diarrhea. The diarrhea was the worst. The constant call of nature meant I had to endure the mental anguish of visiting the “blue room,” as we called the portable toilet made of blue plastic. Unless caught immediately after a visit from the SST (Sh-Sucking Truck) , the blue room was the nightmare of any obsessive compulsive. Once, on one of my 5–6 daily runs, I entered only to find that someone, presumably with a passive-aggressive personality, had defecated in the urinal. Given the angle of approach required for such a feat, the individual must have been a gymnast or contortionist before joining the military. Anger and frustration can lead to some amazing acts.

Given the level of morale at the base, I did surprisingly little work as a psychiatrist while in Kuwait. This troubled me, as I didn’t want to lose my skills. I tried to advertise my presence, and eventually, word got out to units around us that a psychiatrist was available “a few tents over.” Soldiers in our unit or others that had trouble adjusting would meet with to me, usually brought by a senior enlisted supervisor who had noticed something was wrong. I would talk with these soldiers sitting in the sand. At the end of our talks, I’d write up a brief note, give it to them, and instruct them to place it in their medical record. Even if they had to wait until they redeployed, I stressed the importance of keeping that note in case there were any problems later during the deployment or after deployment back home.