Report; Interrupting Pharmacist Improves Prescription Accuracy.

OMAHA, NE (Drugmonkey News Service)- In a surprising report that may have major implications for public health, researchers at Creighton University released a new study today that shows a wide array of distractions to the prescription filling process can decrease misfiled prescriptions by as much as 90 percent.

The report surprised everyone that is, except for you, who knew it all along.

"For well over a century, pharmacy as a profession has operated under the assumption that the tasks of its practitioners would be better attended to if attention were paid to them. Calculating overdoses, evaluating the significance of potential drug interactions, accurately transcribing verbal orders and answering questions from both other health professionals and the general public, it seemed intuitive that some level of concentration should be allowed for, but now we can conclusively say this isn't the case." said lead researcher Burt Von Klaussen. "It would seem as if pharmacy customers had it right all along. The more times a pharmacist is interrupted in the process of filling a prescription, the more you can trust that prescription to be filled accurately"

The muti-year, muti-center study, funded by CVS, found that while the activation of a fax machine in the background had a significantly significant impact on prescription accuracy, it paled in comparison to the most effective method, having a pharmacist stop what they were doing, walk over to the other side of the pharmacy, and be asked by you what was taking so long. That maneuver almost completely eliminated prescription errors.

"While we would love to be able to implement a "What is taking so long?" step into every prescription we fill, unfortunately, it is cost prohibitive at this time." said CVS Chief Operating Officer Larry J. Merlo. "Fortunately, our new program of adding a full time employee to do nothing but stare at the pharmacist from the other side of the counter and sigh periodically is producing exciting results, with errors already down 25%, our corporate malpractice rates have been reduced."

Number three drug store chain Rite Aid responded to the study by installing air-raid sirens that will randomly emit 100 decibel blasts from the main computer workstation in 2,000 of its stores. Analysts said that while the extra noise ultimately should have a positive effect on the troubled retailer's pharmacy operations, the company may have erred by deciding to spend $11 trillion on the new system, and financing that amount over the next 2 years.

"I don't understand what the deal is, God I have a tee time in 10 minutes!" You said when reached for comment. You then proceeded to stand right next to the cash register while people were being rung out, increasing the chances they would be willing to ask about their medication's side effects by 15 percent.

Vacation Post Number 2: Ends And Beginnings. Mostly Ends.

Two miles into the 17-mile Redwood Creek/Tall Trees Grove loop in Redwood National Park, you cross a stream and the real fun begins. Two miles in is where you leave the hum-drum mountain meadows and start to see some actual redwoods, which is, after all, why you came in the first place. It's easy to think of your hike as actually starting about two miles in.

Which means, 13 miles later, when you cross that stream again on your way back, it can be easy to forget you have about an hours worth of hiking left to do. Which can make for a long hour when your legs have been churning since sunup. It was during this hour that the thought first occurred to me. Ever.

Maybe I should retire from this hiking stuff. Not never set foot on a trail ever again, but the first inkling that maybe the days of the 20-mile all day adventure may be numbered. I've had a personal trainer for awhile now, and the result of all her sadism over the course of the last year, the huffing and puffing and pressing and pulling and the unmentionable stuff she makes me do with those giant balls, is that my performance on the trail is about the same as it was last year. I'm 41 years old now, which means stagnation will soon become retreat, and you don't get back the ground you give up on this side of 40. Ever.

It was just the thoughts that come at the end of a tiring day I'm sure. I'll throw myself back onto the trails a few more times. But for the first time, I thought about stopping, which means there is a last time on the horizon. I wonder if I'll know when it is, or whether it will be like the last time I had Mom's scalloped potatoes. I don't know what it was that made me chow down on them so when I was a kid, but I never will again. Mom is old and frail now, and although I don't doubt she would make every effort to start peeling the spuds if I ever asked, of course I won't.

The last time I ate scalloped potatoes. The last time I heard Joe Nuxhall do the play by play for a Reds game. The last time I climbed the maple tree next to my bedroom window. The last time me and that insane crowd of ADD crazed lunatics I ran with as a teenager loaded into my friend's van and went into town looking for trouble. All occasions that surely would have been noted had I known, but as it is all occasions long forgotten.

I do remember the last time I saw my ex-wife. She came to California before the divorce paperwork was done because she wanted to see this place I had run to. "You picked well for yourself" she said, and the tone of her voice made it worse. The fact there was no yelling or screaming made watching that 737 take off, speed away, and gradually shrink into a tiny dot on the horizon that much harder. I'll never forget that feeling. That the burning down of my life, for better or worse, was now complete. That end was definitely noted.

It's been better for the most part, I'm certainly never going back to Ohioland, but,  these trips to the redwoods of mine, the way I almost obsess about seeing no one else, the manic desire to get away in order to get some peace in my head, they feel a lot like mini-burndowns. Except in the end I always end up driving back to that dot on the horizon. Maybe these trips are a good thing, a pressure valve. My legs are awful sore though. And my feet. And my knees. And this year, my hip. This was the first trip where I made sure the ibuprofen was with me at all times. What happens if/when my body can't keep up the pressure release routine?

I suppose the key is to replace the lasts with some firsts. Not sure what they'd be though. I don't think I'd be a very good quilter. Maybe stamp collecting. Of course I could stop running away. Stop fantasizing about destroying the world I built. Again. Or I could keep throwing myself into the woods until my legs fall off.

Being legless has more appeal to me than stamp collecting at this point. I'll ask myself again the next time I pass a 13 mile mark.  

The Sequel To The Sequel To My First Redwood Trip. I Should Just Quit Kidding Myself And Move.

In hindsight, it wouldn't have been a bad way to die. I've been on vacation you see. I set up that Space Invaders post to publish while I was away. I can be sneaky like that. While you were reading about the great interplanetary war of the early 80's I was once again spending quality time with the giant redwoods.

First though, I would have to get across the Golden Gate Bridge. 

Bridges freak me out you see, which was always a great source of amusement for a past significant other. She never failed to make light of this alleged irrational fear whenever we had to drive over one. Every time I would explain to her that the fact I can't swim made my phobia the height of logic, and every time she would inevitably come back with some sort of garbage about how giant steel bridges don't just collapse into the sea. Every time we made it to the other side and she would get just a little more smug. It pissed me off.

This time though, about halfway across The Golden Gate Bridge, I got sideswiped by a guy who drifted out of his lane.  If things had gone a little differently it would have been perfect. I could have had "I told you so" carved on my tombstone and I would have been remembered as some sort of psychic. As it was, it was just a little love tap that messed up my drivers side door to the point where it would only open halfway. We exchanged insurance information and I carried on. 

Later I noticed a Quest Diagnostics car. Again. This has been my third trip to the redwoods and every single time I have passed one or more little econoboxes on the highway north of San Francisco emblazoned with the Quest Diagnostics logo. 

What's going on here? Seriously. Why is there a constant army of Quest Diagnostics vehicles making its way out of the city? Is Quest Diagnostics involved in some sort of plot to remove the kidneys from homeless people living on the streets of San Francisco in order to transplant them into the more affluent population of Sausalito and Novato? I'm not saying that's what's going on here, only that it would be far from the most irrational explanation you could come up with.  

Three-quarters of the way to my cabin I pulled over at a rest stop to pee and eat one of the sandwiches I packed. As soon as it was unwrapped a little hippie girl came out of nowhere:

"Excuse me sir, but do you have any extra food?" 

"I thought you were gonna hit me up for some change"

"No, we're saving our money for gas but we're really hungry"

By gas I suspected she meant meth, but my heart softened and I gave her a couple of my sandwiches. I knew how hard her stomach had to be sending empty signals to her brain if she could feel them past the speed, and methhead or not, she definitely looked like she could use the protein. Five minutes later she was back. 

"Do you have any mayonnaise?"  

My goal on these trips is to have more contact with elk than people, and so far the people were up 2 to 0. I think you can see why I was rooting hard for an elk comeback. 

Day 2- I rounded a curve and saw a lady pulling up her pants beside the trail. An incredibly unattractive lady. I suppose if you gotta go you gotta go, but....make an effort at discretion? Sigh. People 3, Elk 0. 

I ended up in a redwood grove named after a man who made a fortune in the lumber business. A guy who basically paid a shitload of money to slap his name on a few of the trees he couldn't get around to cutting down while he was alive. If you look closely you can kinda see a face in one of the trees in this grove:

I'd like to think that the Redwoods, being the force for good that they are, captured the spirit of the lumber baron, and that's him trying to get out.  

That night I fell in love with Jim Knipfel. Awhile back an anonymous commenter tipped me to this guy, and I owe the anonymous one at least a gallon of scotch in gratitude. Jim is a writer for those of us who realize that most of those we share the planet with are irritants and life is most assuredly not a happy ending. Check out his past newspaper columns here and go buy a copy of all his books right now. I read "Ruining It For Everybody" in one sitting.

Day 3- The night before, as I was fading into sleepyland, I heard what what sounded kinda like a chick getting nailed......aaahhh-UNN.....ahhh-UNN.....ahh-UNN!!! Over and over. As the fog descended over my brain though, I remembered I was in a cabin, and therefore didn't have neighbors in the next room. The sound also seemed to be moving, up the highway, and then back around to the other side of the cabin, then slowly away. I assumed it was just Bigfoot and went to sleep. Now though, in the bright daylight of morning, the sound was back, coming from yet another location...

aaahhh-UNN.......aaahhhh-UNN...

Maybe it was an evil spirit waiting to be captured by a redwood. I figured I should get moving. 

On the trail though,  progress. Seventeen miles and not a human to be found. Here's where I wrote a Drug Topics column you'll probably see in a couple months:

I saw my favorite group of redwoods and asked them wassssup. They asked me if it was just them, or if there was less fog around than there used to be. I said I'd get back to them next year, which is like 2 seconds in redwood time probably. 

That night I started "The Big Short" which may turn out to be the most readable account of what exactly happened during the great financial meltdown of 2008. It did not make me miss humans at all. 

Day 4- GGGGGGGGGGGOOOOOOOOAAAAAAAAAAAAAAALLLLLLLLLLLLLLLLLLLL!!!!!!!!!!!!!!! Thirty minutes into the day's hike I see this guy:

Here's the view from where I spent most of the afternoon:

I read more of "The Big Short" and learned that one of the few people who saw the subprime mortgage crisis as the economic time bomb that it became was a doctor with Asperger's Syndrome who quit medicine because he couldn't handle the required contact with people, started a hedge fund he ran from a room in his house where he kept the shades drawn most of the day, bet against the big boys on Wall Street, and made 800 million dollars. My hero. Oh, and he has a glass eye. I love the fact that one of like 10 people who saw this mess coming had a glass eye. 

On the way back I ran into this:

I counted twenty of them, which put the elk back in the lead. The buck in charge took a few steps toward me, then walked alone along the other side of the meadow at the same pace as I did. Evidently he was like the small town cop who follows you to the edge of town to make sure you're just passin' through. It was the most logical interaction I had with another living creature all week. I wanted to hug Mr. Elk, but I'm pretty sure that would have gotten me gored. 

That night I faded too sleep with MSNBC's "Lockup" in the background, and I'm pretty sure I heard someone say "These kids today don't know how to act like proper gangsters anymore." I'm not sure whether to take comfort in or be terrified by that statement. 

Day 5- The last day of these trips are spent as a windshield tourist, my body usually being sore and broken and in need of a rest by this point. This is an actual sign you'll see by the road smack dab in the middle of Redwood National Park:

Uhhhhh....yeah.....thanks for that. I was definitely back in the land of the humans. I tried to keep it out of my mind as much as I could by spending most of the day pretending I was actually an elk on some sort of undercover spying mission. 

When I got home, I saw the blinking light on my answering machine and knew it was my insurance company. Sigh.

At least I have reason to be fearful of bridges now. 

Thirty Years After The Great War, A Soldier Tells His Story.

They told us it wasn't a war about water, but we knew better.

How could it not be? Have you ever seen a picture of that planet? The bright blue will almost blind you if you don't put on your special gamma-ray combat spectacles. And the parts that aren't blue are almost a perfect white from the water in their atmosphere. These creatures literally breathed water! Rumor had it their bodies were almost 80 percent of it. That's they kind of crazy shit you hear in combat. The tales your commanders will tell to try and de-glockerize the gockerizans you have been sent to kill.

Or, I should say, sent to be killed by. They lined us up in neat little rows, one behind the other, and told us to just keep going. We told them it was insanity, that it was a slaughter waiting to happen, but our words fell on deaf ears. Column after column was mowed down by their base cannon. I lost some good friends that day. Some of the best Glockerites you ever would have had the pleasure of knowing. I still hear their cries sometimes at night. I still see them in my dreams.

Why did they just march us straight at them like that? How could they not know they were getting 20 shots off for every one we could fire? I was only 19 years old, and I was terrified. We told them every time they flew over in one of their command ships that this was a turkey shoot, but even after three of their command ships were destroyed, nothing changed.

Continue forward the orders read. Increase your speed.

I can't claim to be a hero. I don't even remember firing the shot that was the one that destroyed their last base cannon. I just remember the cold. Cold that would freeze you down to the last froggio of your being. I was no braver, no smarter, no more worthy than any of my brothers left on the battlefield that day. Yet fate chose me as the one to live.

In the end we got their water. We installed Reagan as their leader and he gave us all the water we wanted. We started pumping carbon dioxide into their atmosphere and as soon as that shitty little planet of theirs warms up enough to support decent Glockerzians, we have a new colony.

I can't help but to think if it was worth it though. I know it sounds heretical, but sometimes I think that if maybe we just would have invested more in wind and solar energy, my brothers would still be alive.

I can admit it now. It was all about the water.

From The "I Really Wouldn't Be The World's Worst Parent" File. (Part 1)

SALINAS, Calif.—A California couple faces child endangerment charges after police say they tried to sell their 6-month-old baby for $25 outside a Walmart store.

Salinas police spokesman, Officer Lalo Villegas, said Thursday that Patrick Fousek, 38, and Samantha Tomasini, 20, were arrested early Wednesday, hours after Fousek allegedly approached two women outside Walmart and asked if they'd like to purchase his child.

Walmart. Low prices. Always. I was out baby shopping just last week and Macy's wanted $150 for their babies. On sale. Couple that with the $4 amoxicillin for the kid's first ear infection and you gotta ask yourself, why you would shop anywhere else?

Fousek and Tomasini were arrested at 1 a.m. Wednesday at their home. Officers said the couple appeared high on methamphetamine and the house was in disarray. A police report also claimed that Tomasini told Child Protective Services, who took the baby, that she had breast-fed the infant while under the influence, Villegas said.

"It was my way of pinching pennies" Tomasini didn't say. "No matter how much of a crack whore I became, there just never seemed to be enough money for both of our Adderall prescriptions. This way I could treat both of our ADDs at once"

You know I write tongue in cheek. Keep reading if you yearn for any sense of justice in this world.....

From The "Who Knew The Nation's Prisoners Had Such Family Values" File. (Part 2)

Under heightened courtroom security, two Salinas parents were arraigned Friday in connection with an alleged attempt to sell their 8-month-old daughter.

Patrick Alan Fousek, 38, and Samantha Tomasini, 20, are being held in segregated, lockdown cells at the Monterey County Jail, Fousek after an attack by inmates Thursday night.

Sheriff's Cmdr. Mike Richards said inmates in the open dorm where Fousek had been housed jumped him at 10:15p.m. after the details of his charges were reported on television news.

Richards said Fousek was transported to Natividad Medical Center, where he was treated for multiple injuries to his face, and two cracked ribs before being returned to the jail

OK, in all seriousness now, there are really no winners here. A child's life thrown into disarray. Two people caught in the vicious web of drug addiction, and now, with a dash of senseless violence......

ok...wait.....I can't do this anymore.......

BBBBBBBWWWWWWAAAAAAAAAAAHHHHHHHAAAAAHHHHHHAAAAAAA!!!!!!!!!!! THEY BEAT THE CRAP OUT OF HIM AFTER SEEING IT ON THE NEWS!!!!! BBBWWWWWWWWWAAAAAAAHHHHHAAAAHHHHAAAHHHHAAAAA!!!!!!

I just....snicker.....can't get the image....chuckle.....of the split second after the news story....hee hee.....when everyone turned around and looked at the dude...ha ha...out of my head....

BBBBBBWWWWAAAAAAAAAHHHHAAAHHHHAAAHHHHAAAAAAAAAA!!!!!!!!!!!!!!!!!!!!

Seriously, you didn't think I was that much of a bleeding heart did you?

Me thinks there are some prisoners who have earned a little extra meat in their dinner this night.....

Now We're Not Saying Osama Bin Laden Uses Flomax....

Actually, yes, that's exactly what we're saying:

Tricare, for those of you playing along at home, is the socialized medicine program that covers our nation's active and retired military personnel. I've never felt so proud to be an American as the first time I filled a prescription for Uroxatral.

I gotta tell you though, even if Flomax is the drug of evildoers, the remedy of all that stand against us in the great struggle of civilizations, the cure of godless, soulless, despotic communist terrorists who get up multiple times during the night to pee, I don't want that bird, and especially that beak, anywhere near my prostate.

I'll have what Fidel is having, thanks.

I Think The Fact I Can Wax Philosophic About Tiger Woods Is A Testament To My Great Mind. Because I Really Hate Golf.

Not the sport so much. Mostly it's the type of people that play golf that I can't stand to be around. The smug arrogance that comes from being born on third base and being convinced you hit a triple. That's what you see when you look into the eyes of a golfer. Fierce defenders of their unearned privilege. They will never hesitate to lecture you about how ours is a society where people advance on the basis of merit and then do things like this to the most meritorious among them:

Alas, his best was not quite good enough. Shortly after he won the US Amateur Championship for the first time Woods was approached on the driving range by a then club employee who, according to numerous sources, told him he would have to leave because there had been a complaint about an "n word" hitting balls there. "There was no way Tiger was hitting balls into anyone's back garden," says Rogers. "He wasn't a bad enough golfer."

That would be Tiger Woods. Ten years ago Tiger Woods won the US Open by an incredible 15 strokes, a feat that remains one of the great performances in all of sporting history. I don't have to tell you Woods was in a universe of his own on the golf course 10 years ago. I probably do have to tell you that he was made to carry a receipt for anything he bought at the country club where he practiced as a child "because there had been complaints from members." Or that his mother wasn't allowed to bring food to a clubhouse party celebrating one of his tournament wins.

"I used to think they treated him badly because they were pricks but the more I think about it they were probably racists, too" said an article I remembered reading a few years ago but had to comb through the web unbelievably hard to find. Americans don't like to read about ugly truths. We like to imagine a world where people like Tiger Woods are nurtured and recognized for the incredible talent they are instead of being spurned when they offer to let that country club display the trophy from a US Amateur championship.

And then we act baffled when they self destruct. Today Tiger Woods is a walking punch line, he is battling a neck injury, and he faces the real possibility that he will lose custody of his children. A lot of his problems are the result of his own foolish decisions, yes. But I am well aware of how bad karma placed in a child can be the source of foolish decisions when that child turns into an adult.

So are you. Except for one or two of those fuckers you'll find sipping a beer at the clubhouse of your local country club, we've all had bad karma planted in us. No one makes it. No one's happy. Elvis Presley was successful beyond any of our wildest dreams and died fat and in a narcotic haze struggling to take a shit. It makes us feel better about ourselves though, when a public downfall is unexplained. We remember the bad karmic seed within us and think if not for that we would have won our own US Open or made our own gold record and would have handled the ensuing success so much better than that schlep. There was a reason for our foolish decisions we say to ourselves. Tiger Woods, on the other hand, must be an idiot.

Today Tiger Woods shot a 66 and vaulted right into the thick of the hunt for this year's US Open championship. I hate golfers. Which is why I'll be hoping he pulls it off.

Maybe If Wyeth Had Paid Me $2000 Like They Did At Least One Doctor, I Would Tell You How Great Rapamune Is. Until I Get That Check Though, I'll Just Tell You How They're Accused Of Illegally Marketing It.

I've been accused, at times, of being a left-wing partisan. Of being a part of a vast media echo chamber whose mission is to parrot the talking points of the day handed down from our socialist overlords in order to meld the clay minds of the under-informed to secure the votes we need to implement the nightmare that would be a society more just and fair.

To which I would say this, would a member of a vast liberal plot to coordinate the thoughts of this country ever tell the Huffington Post they were dead wrong? Because that's exactly what I thought after I read this bit from a post there last month:

In a stunning whistleblower lawsuit, the world's largest pharmaceutical company is being sued over the dangerous practice of illegally promoting a kidney transplant drug for unapproved uses and targeting African-Americans, even though they are at high risk of complications.

...Sandler and Paris claim that Wyeth, which is now owned by Pfizer, promoted the "off-label" use of Rapamune, a kidney transplant drug which generated $376 million in sales in 2008, encouraging its sales force to promote the drug for heart, lung, liver, and pancreas transplants even though Rapamune was never approved for those procedures. The Food and Drug Administration warned against such off-label use of Rapamune in 2004 and 2007.

Um, excuse me Huffington Post, but maybe you can get your facts straight. Let's dig a little into the record, shall we?

A division of Pfizer Inc., the world's largest drugmaker, has agreed to plead guilty to two felonies and pay $430 million in penalties to settle charges that it fraudulently promoted the drug Neurontin for a string of unapproved uses.

And a little more:

As part of the record settlement, Pfizer agreed to pay $300 million to resolve allegations that it engaged in off-label marketing of its blockbuster atypical antipsychotic Geodon

And the hits just keep on a comin':

Pfizer also agreed to pay $100 million to resolve allegations that it improperly marketed its antibiotic Zyvox.

So I think by "stunning" what The Huffington Post may actually mean is "routine" My search for that famous liberal media bias I keep hearing so much about continues....

What is mildly surprising about this latest of the improper marketing lawsuits that seem to have a way of piling up at Pfizer's doorstep is the racial aspect. From the lawsuit:

In 2005, Wyeth’s sales management (headed by National Director of Transplant Sales Joe McCafferty) selected Philadelphia’s Einstein Medical Center as a center on which to focus a Wyeth marketing plan designed to rapidly increase or accelerate Rapamune sales in a 90 day period. Einstein’s transplant patient population was approximately 75% African-American in 2005.

Now from bnet.com

The suit claims that there is limited data on Rapamune use in black patients, who need a different dosing regimen than whites. Nonetheless, Wyeth targeted another hospital that primarily serves the black community for Rapamune “conversion.” Conversion is the practice of switching a patient from their existing transplant drugs to Rapamune. The FDA has only ever approved Rapamune for first-line use in kidney patients, and since 2004 the drug has carried a black box warning against conversion. Even Wyeth’s own internal studies did not show improved outcomes on Rapamune converted patients:

So, in 2004, a black-box warning was included in Rapamune's prescribing information against conversion. And in 2005, which is after 2004, Wyeth targets a hospital that serves primarily African-Americans to see if they can get some conversion happening.

I wish I could say that was stunning, but yeah, I'm sticking with mildly surprising.

"We prefer to think of it as an affirmative-action program" said Pfizer Chairman and CEO Jeffrey B. Kindler in an imaginary interview. "Actually more of a tribute to the many ways African-Americans have added to the mosaic that is America. Just as John Coltrane didn't follow the rules of music when composing his signature style of jazz, just as Martin Luther King did not always follow the rules of society as he led the struggle to defeat Jim Crow, we at Pfizer did not feel bound to follow the "rules" when striving to serve the African-Americans who are such an integral part of our experience as a nation."

Back to the real world now:

The suit describes a speakers list of 18 physicians who could talk about off-label use of drugs. One of those cited was the Cleveland Clinic's Dr. Stuart Flechner, who was available to speak about the use of Rapamune "for an honorarium of $2,000 or "prorated $15,000." Flechner, a fellow of the American College of Surgeons, was named one of the Top Doctors in America, according to the clinic's Website.

When doctors at Mt. Sinai Medical Center expressed concerns about using Rapamune as part of a specific regimen, Wyeth brought in Flechner to talk to them:

"Wyeth paid Dr. Flechner to assist in the marketing of the unapproved combination of Cellcept, an IL-2 receptor antagonist and Rapamune in order to overcome these objections and secure Rapamune sales."

I wonder how you spend blood money? Other than on some Ambien to help you sleep at night, I do wonder what you get when you sell your soul as people are struggling for their lives?

And I wonder when we're going to wake up. The corporations on Wall Street came within a whisker of destroying the world's economy with their little derivative games a couple years ago. The corporation with the warm and fuzzy green logo that says it's "Beyond Petroleum" is in the process of destroying this country's Gulf Coast with petroleum. And now, once again, the corporations that we entrust with our very lives seem to be comfortable with sacrificing a few of us in order to makes this quarter's sales goals.

And yet the more liberal among us still claimed to be stunned. The first step to a solution my friends, is to lose the surprise.

Wake...up.

Rewards And Realization And.....God I Wish I Was Stupid Sometimes So Thoughts Like These Would Quit Going Through My Head.

I deserved the heart attack on a plate that is a full serving of Denny's nachos. For I kicked ass this day at work.

Tech didn't show up. Tracked him down on his cellphone after half an hour and he said he had talked to the manager about taking today off. Something about his brother's graduation. Said he was sorry and he was on his way.

I thought of all the holidays I worked as an intern to avoid the family and felt a twinge of jealousy. I told him to go to the graduation, and thus sealed my fate.

They came at me with full force. Waves of them waving little papers from the urgent care. Tourists not familiar with American drug prices. People expecting faxes that were not there. Prior auths that were not understood. Phones that never quit. I was mowing it all down my friends. Then the computer crashed. And I handled that too. And could have beat out those clowns at CVS in a professionalism contest with one hand tied behind my back as well.

Because work seems to be the only part of my life functioning normally at the moment. Behind the counter the only time my brain chemistry feels normal. I mowed down the prescription madness this day in a way only an experienced professional could. And for the first time in a while all was right in my head.

Then my shift ended. My mind rewarded me with a little endorphin action and a craving for nachos. Which tells me dopamine may have been involved as well.

It was the waiter's first day. I knew it before he told me. The overeagerness gave him away. He hadn't given his all towards a customer only to be stiffed when it came time for the tip too many times yet. He would be. A few minutes after he took my order he seated a family of four in front of me and I felt a twinge of the jealousy like I felt towards my tech this morning. The family seemed normal and happy and therefore fascinated me. The waiter joked with them and made the little boy wearing a superman shirt laugh. I studied them over the top of my newspaper. It was when superman boy said he had to go to the bathroom that I first saw it. The look on Dad's face. He was tired. Distant. The joy in this family was coming solely from the lady and the kids. This guy wanted to be a million miles away from wiping his kid's ass on a Denny's diaper changing table. I looked at him and remembered my twinge of jealousy and knew he would be seething with that same emotion if he could have known of my last weekend. Any married man would have loved to had been me last weekend. Last weekend I scored in a way almost straight out of a Penthouse Forum and afterwards felt about as empty as the look on this married man's face as superman boy begged him to watch him crash two toy airplanes into each other one more time.

No one is happy. Each of us had a little of what the other wanted and neither one of us would be happy if he got it.

The waiter came back and continued to joke with the family. Things seemed to be going well until he said something about an outfit that made him "look retarded." Retarded is a word on the cusp. In 10 years it will be said in public no more. There will be a new word and in 30 years that word will no longer be said in public. Today though, retarded is the kind of word that will wrap a blanket of silence around a conversation when said in front of the wrong people. And maybe cost you a tip.

I put the nachos in my stomach and went past the time of my endorphin's first half life. I left the waiter 20% of my bill and wished him well in my mind. I worked the crossword in the paper as the dopamine slipped away. I was sated. Even if I didn't know a 5 letter word for pretentious.

Reality slowly slipped back into my brain like the tide flowing across the beach.