Where The Rubber Meets The Road

Once upon a time, I was healthy and whole. And I’m not talking about the teenage years, when you could be dragging a broken leg behind you, bone sticking out the side, and you’d still want to go clubbing or some lame shit. No, I’d take just being thirty-seven and getting a good night’s sleep. I’d accept the lower back pain, or the diminished athleticism, or whatever the ravages of time threw my way. It would be better than exposing one’s self to western medicine.

One evening like any other, I woke up breathing as if I’d run a marathon. And every evening since then, it has been a struggle to sleep. It took a very long time to figure out what had done this; we (the “professionals” in our disease/symptom industry and I) went from simple suggestions like smoking to far-flung ideas like night terrors or panic attacks. Finally, after several sleep studies, I discovered that it was actually sleep apnea. If you’ve never heard of it, sleep apnea is when you stop breathing while you sleep. There are several types: obstructive, wherein your airway collapses; central, wherein the brain doesn’t tell the body to breathe; and complex, wherein both occur. Obviously, of the three, complex is the worst, and if you’ve already guessed that this is the form I suffer from, have a cookie (or a shot, if you’re playing the Randy’s Medical Maladies Drinking Game™).
The treatment for complex sleep apnea (of course) is expensive. The necessary machinery alone costs in the tens of thousands (unlike, say, obstructive, which can be alleviated for a couple hundred dollars). Quitting smoking, sleeping on your side or at an angle, as well as other “home remedies” can help the obstructive part of complex sleep apnea, but the machine is needed to clear up the central component. Alcohol and narcotics can make things worse. This becomes important information… now:

The lack of sleep and additional stress managed to knock my immune system down enough to awake the now-mutated Varicella Zoster Virus (VZV) that lies dormant in every person who has ever had Chickenpox, which is just about everybody. The reappearance is called Shingles, or Herpes Zoster. Astute readers can have another cookie/shot if they’ve connected the dots (no pun intended) and realized that if they’ve had chickenpox, they’ve had a strain of herpes. The conversation with the doctor went something like this:
“Mr. Chestnut, you have Herpes Zoster.”
“What?!?”
“Herpes Zoster.”
“WHAT?!?!!”
“Shingles.”
“Well, then you fucking say ‘shingles’. Don’t come at me with this herpes shit.”
“Mr. Chestnut, herpes zoster is shingles.”

Shingles comes about largely due to immunosuppression, which can be the result of stress, age, or some other disease – usually HIV. Guess who ran – RAN – to the nearest clinic to get tested? Never has the word “negative” seemed so positive. The nurse at the clinic asked me to sit in an office and wait for the doctor to discuss with me my test results; if this sounds ominous to you, it’s cookie/shot time.
“Mr. Chestnut, if you’ll just have a seat, the doctor will be in in a moment.”
“So, you have my test results?”
“The doctor will be in in a moment.”
“But you have the result?”
“Yes, but the doctor-”
“Lady, I will bury my foot in your unmentionables if you don’t cough up a result.”
As it turns out, HIV clinic nurses are not easily cowed. The doctor came in, brandishing a piece of paper that declared me free of HIV. When he asked if I had any questions, I (this is true) said, “Do you guys have lamination or a framing services?”

But I digress. Shingles hurts like the ubiquitous motherfucker. My leg ached, burned, stabbed, and prickled for weeks. The Vicodin™ they gave me was a joke.
Wait a minute, says the astute reader. Isn’t Vicodin™ a narcotic, and didn’t you just say that narcotics exacerbate sleep apnea? Have a cookie, reader. (Stop taking shots, or you’ll pass out before you finish this entry.) Also, kudos for use of the word “exacerbate”.
Yes, the apnea grew worse under the tender care of doctors. And worse still, as the pain did not recede when the rash of shingles went away. And here is where the doctors became the soulless heathen bastards they’ve always been. It took another series of trips through the doctoral food chain before someone would finally admit that what was happening was happening. In truth, I just started telling them that I’d self-diagnosed (which doctors absolutely hate, and will blindly deny that you are right, even if the self-diagnosis is a missing limb, while blood drips on their floor from your raw stump). The problem was Postherpetic Neuralgia(PHN), a rare complication of shingles that basically means the virus has damaged and disrupted the nerves, causing them to send pain signals to the brain for no reason. Have another cookie.
The process was lengthy; first, I was put on various useless, ineffectual drugs that had to be ramped up and tapered off because of the withdrawal effects. I was put on these because the first 8 doctors didn’t want to put me on pain-killers because of the chance of addiction. Note: They used the word ‘addiction’, and not ‘dependency’. ‘Dependency’ implies that my body will eventually require the drug and pitch a fit if I’m not on it; ‘addiction’ implies that I will abuse the drug. Thank you for the assumption, assholes. Anyway, the irony was not lost on me: Refusing to relieve my pain because of the withdrawal effects by giving me drugs that did nothing except for the withdrawal effects. Okay…

Gabapentin, Pregabalin, Amitriptyline, they didn’t work. These, by the way, were prescribed in what is referred to as “off-label use“, a term that means the drug’s unintended side effect is the preferred result, which tells you how irritatingly self-absorbed these pricks are about sensational stories involving prescription drug abuse. I wasn’t trying to start a trendy drug habit after thirty-plus years of eschewing them; I was trying to get back to some semblance of life. Eventually, I got to Doctor 8, who gave me oxycodone. And for the first time in a long time, I could function without much hindrance. It didn’t take all the pain away (nothing does or can), but it made life a lot better. Furthermore, there were no major side effects (excepting the aforementioned increase in apnea). Huzzah! Of course, there was the other expected problem with any opioid analgesic; sooner or later, you pretty much have to be on it all the time. I’d been crossing my fingers that the PHN would self-correct before I reached this point, but you know me. If Dobie Maxwell hadn’t already used it, I would have been ‘Mr. Lucky’. Cookie time!

And then I switched insurance, and had to seek out new doctors who were covered by the new plan. The first one (Doctor 9) was so incredibly unprofessional, such a complete and total dickbag, that he actually refused to speak with my previous doctor. He simply smiled his vapid, smug smile and said, “Tough shit”. Note2: After visiting the pain specialist(s) (Doctors 10 & 11), Drs. 10 & 11 attempted to get Dr. 9 to prescribe me the medications they recommended. I don’t know exactly why, but shortly thereafter, the UW Medical Foundation kicked Dr. 9 to the curb. I really, really, really hope that my case had something to do with it. Get shot and have the ER refuse to give you painkillers, Dr. 9, you fuck. Well, finally Doctor 12 stepped in, because Drs. 10 & 11 apparently weren’t allowed to prescribe more than Cymbalta (another off-label use, this time an SSRI they didn’t warn me about – cookie), and gave me a prescription for methadone. Why? Because they wanted me on an extended-release drug, and not an immediate-release drug. (Astute readers will notice that – having finally given up the ghost on their ludicrous belief that I would go on a Reefer Madness-style mania if given anything stronger than Advil™ – the doctors were now throwing the strongest narcotics possible at me like the raging hypocrites they are. Also, astute readers are now choking down yet another cookie.) The Cymbalta made me nauseated (threw up about 12 pills on it), restless, sleepless, and a little bit crazy. The methadone – on the lower dosage – didn’t cover much of the pain (unlike the oxycodone, despite supposedly being 10 times stronger), and also made me nauseous. On the higher dosage, I couldn’t eat at all. After consulting with Dr. 12, I was given Morphine Sulfate extended release, which – get this – is half as strong as oxycodone. So, it does an even more piss-poor job of pain relief. Also, it makes me very, very sleepy. As in, I can’t sit or lie down anywhere without starting to nod off. However, morphine also exacerbates – guess what? – sleep apnea. Yes! Now I get even less sleep! COOKIE!!!!!

Also, I was taken abruptly off the Cymbalta, so I was in withdrawal in addition to being in pain and sleep-deprived and terrified of sitting down or lying down because it immediately caused an apnea-episode. Oh, and mildly queasy.

(Right here is where the apnea was diagnosed, so all apnea-related griping thus far has been retroactive, though I would argue that it has the merit of accuracy.) What follows is just more fun insurance-doctor Keystone Cops silliness: Then, the Sleep Clinic (Doctor 13) sent me to Meriter Home Health (MHH) for a machine to fix the apnea. MHH said they needed an authorization for the machine. So I called Dr. 13, and was told they sent the authorization over a week ago. So I went back to MHH, who said that yes, actually, forget what we said earlier; we got the authorization and sent it to the insurance company. That’s the authorization we, uh, um, yeah, meant. Really. That’s the ticket. So I called the insurance company, who also said they gave the authorization a week ago. Back at MHH, they said, “Yes, okay Mr. Smartass, we got that authorization, too. FINE, we’ll rent you a goddamn machine so you can get your precious fucking sleep, you big fucking baby. Jesus, we hate people.”
Except that way back at the beginning of this clusterfuck, they authorized the wrong machine. Cue MHH laughing gleefully, and have another cookie. If you’ve kept taking shots instead of cookies, please call 911 now, as your blood-alcohol level has now reached fatal toxicity levels.

So, there I was. Unable to think straight through the fog of sleep deprivation, nauseated, unable to sit or lie down, shaking, sweating, and restless from the Cymbalta withdrawal, and my fucking leg still hurt.

Morphine extended release because you wanted a long acting med? How about extended release oxycodone; you know, the one drug that was working, shithead.
Hey MHH, maybe – and this is gonna sound crazy – why not do what every other medical service in the country does: provide me with the service, and then bill the insurance company. Your business is renting various medical equipment to people who need it at home, so – it gets even crazier – why not rent me a piece of medical equipment? Has there been some rash of turning your medical equipment into some kind of souped-up methamphetamine uberbong or something? What exactly terrifies you about offering the service you offer?

Even my wife didn’t believe the unrelenting, rampant stupidity I run into with doctors. She had to see it with her own eyes, and stare, open-mouthed, at the incredible lack of common sense, decency, or competency they exhibit in my presence.

The more doctors I see, the worse I feel.

Epilogue: I’m so afraid to say it. I’ve never been a superstitious fellow, as anyone who has ever heard me talk about religion would know. But, I am deathly afraid I might jinx it. So here goes: Shhh…. Lately, my leg has been hurting less; the days of really bad pain have come less and less, and the days of minor pain have come more – and been less painful. I think the PHN is going away. Don’t tell anybody. I’ll give you a cookie.

It’s Science Fair time, and that usually means two things:

1. Volcanoes, and
2. The Solar System

And this year was no exception. You couldn’t swing a bored grade-schooler without hitting one of these two exhibits. Most of the junior “scientists” couldn’t have cared less about their projects; they were more interested in root beer floats, running off their sugar high from root beer floats, and shrieking at volumes generally reserved for Super Bowl halftime shows and at a frequency capable of shattering Mars (all of them).

Samara was too young to engage in this rite of passage, but Gabe had to endure the trial. After a quick scan of possible topics, he landed on mummification. Specifically, mummifying a hot dog. It was simple enough, and few (in this case, none) of the other kids would follow suit. In science fairs, originality counts. What also counts is the yuck factor, as in a slimy, room temperature stick of processed meat byproducts next to a dessicated, slimy, room temperature stick of processed meat byproducts for comparison.

Gabe’s exhibit was remarked upon most favorably, but was not the only one worth seeing. There was a pretty cool one about how to procure your own recycled paper with a coat hanger, newspaper, water, a nylon stocking, $3.99 plus tax, and a trip to Target. Another great exhibit examined the concept of playing music to plants to stimulate growth and health. The girl who ran the experiment discovered that the control group plant (the one with no music) grew fastest, because “the plant wasn’t all stressed out by loud music”. Sublime.

At 7:30 PM, the appointed time for all parents to laboriously begin deconstructing the projects they’d built 90% of, we bundled up the kids and the hot dogs. Everyone looked like they could use a drink, especially the kids.

It was Science Fair time, and then it was time to go home, safe from the demands of grade-school, good-intentioned teachers with no regard for the sanity of other adults. Until next year.

There are some gigs that you don’t forget. Not because they’re especially great (I barely remember the Terre Haute, Indiana gig where I received my first standing ovation) or because they’re especially bad (although those tend to stick), but because they change you in some way, however big or small. In this case, it was a realization. And I hope, pray, beg, threaten, cajole, and wish with every fiber of my being that it may one day be irrelevant.

Dirk Diggler And The Prison Of Azkaban

3/18/06 – Clarion, IA

Ever been to one of those small town bars where they still play cuts from AC/DC’s Back In Black, and get excited for Def Leppard? Where fortysomething men in quilted flannel shirts and non-sports-related baseball caps encrusted with filth are slumped over the bar, and their wives all bear a passing resemblance to the landlady from Kingpin? A place where you can just smell the defeat in the air; where people go when they’ve given up on living, and are getting down to some serious existence, drinking with a level of commitment usually reserved for life-and-death struggles on the field of battle. It’s as if every second is an unendurable trial, a test of the will to continue being alive. And by “alive”, I mean “killing as much time as humanly possible until the sweet release of death”.

If you’ve been there, you’ve been to the gig I played.

I looked out over the crowd (well, sparse gathering of 27 people), and thought, “There is not a single person in this place I would talk to if I weren’t being paid for it.” Even as an audience, they laugh grudgingly, as if admitting to having a good time would be an acknowledgment of responsibility to start living better.

And yet, after the show, they come up to me and say things like, “Thank you. You made me laugh.”

I made you laugh? Is that such a rare occurrence? Have I brought some ray of sunshine into your life? Have I really?

And I realize: This is Bush America. This is the vision. Broken down worker drones who mechanically shamble through life, and are willing to suffer any degradation, so long as it makes them forget how much they hate their lives. The worst part is, it’s also Clinton America. And Bush the First, and Reagan, and so on, going back to Eisenhower.
I suppose it would be easier to say that this is the America the corporations dream of.

And because these people will not raise their heads and look up at anything that might make them think about changing their world, I end up telling them dick jokes.

I whore out.

I throw in the towel on trying to make a point with my jokes, and “give them what they want”, when I should give them what they need: A swift kick in the frontal lobe. But I don’t kick them in the lobe. I baste their brains with butter and honey, and see them safely back to sleep. It shames me.

I am a star. I’m a star, I’m a star, I’m a star. I am a big, bright, shining star.

I think we are fast approaching an age of affordable beauty – if we aren’t there already.

The “problem” with that is the cultural definition of beauty. Beauty is often dictated in culture by what is difficult to both obtain and maintain. Thus, in the western world, where life is relatively comfortable, being thin or perfectly sculpted are often the most desired attributes. But in another age, when food, hygiene, and good health were scarce, being round and robust were the standards of “beauty”. This is still true today in some (less wealthy) parts of the world.

Implants, collagen injections, liposuction, hair growth tonics, diet pills, and good old fashioned plastic surgery are available to the masses, with decreasing expense. We are becoming a civilization of Mr. Potato Heads. This brings to mind science fiction stories where people, bored with the common appearance, begin adding limbs and tentacles and antennas; dyeing their skin blue, having an extra eye put in, or removing various parts…

Not that this is a bad thing. At some point, this constant alteration will be the province of a new sexual subset: the xenophiles.
Furthermore, I welcome this age of affordable beauty. When Cosmo Girls and GQ Guys become as common as dirt, people will begin to look elsewhere for what is difficult to obtain and maintain. Maybe the new standard of beauty will be an eyepatch, a hook hand, and a pegleg. Think of the possibilities at strip clubs:
“Arr! Which one o’ yeh ordered the lap dance?!? Play with me titties, yeh scurvy dawg!”

I suspect that when we reach the point that the “beautiful people” are no longer rare or difficult to obtain, we might start to think that originality counts. Or – and this is gonna sound crazy – but what if this future age of being able to mold your body into any shape you desire leads to a renaissance in thinking?
When people can wear any shape they want, look like anything they want, what if people start to think that maybe our bodies are just shells, hollow vessels that mean nothing, and they start to look inward, and look at a person’s mind to find beauty?

Wouldn’t that just be the cat’s ass? Yeah, I know, that’s just crazy science fiction talk. What was I even thinking? Forget I said anything. My bad.

I’ve just about had it with stupid people today. To be fair, I don’t blanket name all people who say or do stupid things as stupid. No, I discriminate. There are people who say or do stupid things out of simple ignorance, for instance.

I have (usually) no problem with ignorance. I know, it begets racism, class warfare, religion, ad nauseum, but ignorance isn’t a fixed or permanent thing. It is a condition we all find ourselves in at one time or another, and it’s usually closely associated with embarrassment. I find myself ignorant of something nearly every day, and reflexively shoot up with the only antidote: information. I learn.

Sadly, others do not. There is a brand of ignorance that has become so pervasive over the past, say, 30 years that you can’t swing a fiberglass axe handle without hitting one of the sufferers of such ignorance – and perhaps that should be the law. I call it willful ignorance. And I’ve about reached my tolerance limit for these fucking people.

You’ve seen them. You saw one when John McCain took the microphone away from her in 2008 because what she said was so completely at odds with reality that even his campaign couldn’t spin it. And they somehow spun Sarah Palin, for fuck’s sake.

Willful ignorance differs from the garden variety in a number of ways, but chief among them is that sufferers of willful ignorance know they are ignorant and refuse to learn. Oftentimes – when presented with factual information that proves their ignorant belief wrong – these people react angrily, violently, and disproportinately so. There is an actual psychological disorder that describes this: Delusional Disorder, the indicators of which are:

1. The patient expresses an idea or belief with unusual persistence or force.
2. That idea appears to exert an undue influence on his or her life, and the way of life is often altered to an inexplicable extent.
3. Despite his/her profound conviction, there is often a quality of secretiveness or suspicion when the patient is questioned about it.
4. The individual tends to be humorless and oversensitive, especially about the belief.
5. There is a quality of centrality: no matter how unlikely it is that these strange things are happening to him, the patient accepts them relatively unquestioningly.
6. An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility.
7. The belief is, at the least, unlikely.
8. The patient is emotionally over-invested in the idea and it overwhelms other elements of his psyche.
9. The delusion, if acted out, often leads to behaviors which are abnormal and/or out of character, although perhaps understandable in the light of the delusional beliefs.
10. Individuals who know the patient will observe that his belief and behavior are uncharacteristic and alien.

– Munro, A. (1999) Delusional Disorder. Cambridge: Cambridge University Press. ISBN 0-521-58180-X

Does this sound like someone you know? Someone, for instance, who believes that homosexuality is a choice, or that climate change isn’t happening, or that Seinfeld is funny?

But let me get to the subgroup of people who are really pissing me off: The Willfully Ignorant People With No Sense Of Irony Or Hypocrisy. I meet them, see them, hear them, and/or bury one of their bodies almost weekly. Here are a few typical (if made up) examples:

Idiot: The fucking immigrants are ruining everything.
Me, stealing from Bobcat Goldthwait: That didn’t sound like Navajo to me.
Idiot: My name is Lou Dobbs.

Complete Idiot: My favorite comedian is Dane Cook.
Me: You mean you like Louis C.K., Emo Phillips, and Demetri Martin, since Cook ripped off their material. Also, he’s reportedly a gi-normous asshat.
Complete Idiot: He makes more money than you.
Me: And I make more money than Lenny Bruce did; does that make me better?
Complete Idiot: Who’s Lenny Bruce?
Me: (Stab)

Complete Fucking Idiot: I’m not racist or anything, but-
Me: (Stab)

In this respect, we have lost the Culture War. America isn’t being “dumbed down”. It’s already happened, and I see the result every day. Every time someone falsely accuses me of the very thing they just did. Every time I have to explain to someone what they just read. Every time they try to legislate “good” behavior. Every time I’m forced to watch the next big piece of shit Hollywood production – or even when I’m not forced to watch.

Every time I fail to reason with someone because they don’t even have the semantic tools to understand not just what I’m saying, but what they are saying, I hate them a little more. And I’m tired of being nice about it.