Jack Kevorkian & The Suicide Squirrels

Michigan is rarely more beautiful than these last few days. A kinder, gentler kind of summer is here. Not the oppressive heat and humidity that is usually August, just warm, middling days and nature in full beauty. I hadn't actually noticed until this week...

... when I ran over a squirrel.

My office is a Ford Fusion, and like the Johnny Cash song, I've been everywhere. This week I was in a more rural part of the state where the towns were not accessible via expressway. Vast swaths of green, sprouting corn ran uninterrupted up to careworn farmhouses and oak-lined yards. The country roads meander like the streams they periodically cross and bright light suddenly meets shade as hardwood groves reach over both sides of the road, obscuring the sky.

There is a lot to take in. Honestly I am usually lost in thought while all this rolls by. I must have noticed at some point there wasn't snow on the ground, that it turned green. Some voice on the radio said Jack Kevorkian was released from prison. I turned off the radio. Too many words. Just when I was trying to think about suicide and what it meant, then they were adding words like 'physician assisted', and then someone asserted that Kevorkian actually euthanized people- a thing more austere in that voice's opinion. My mind was full. I hit the button turn off the radio, and ran over a squirrel.

The black squirrel ran into the road to a place that would have been between the tires, then seeing this misalignment, moved two feet to the left. A moment later it met a tire and knew no more. I couldn't avoid it. There a slew of physics involved in getting that car to cruising speed and I was not going to spin into a ravine, losing my life to save his. But it happened right in the middle of this thought on suicide, assisted suicide, and euthanasia.

Weird.

The similar looking farm houses rolled by with more green swaths of corn- no doubt close kin of the others I'd seen. Trees. Nature. None of them stopped to notice the squirrel. Just me for the 2 seconds it took to flatten it. I drove on and thought more about these deathly words.

I've not really given these ideas much thought. I like living and think I'll probably do until I can do it no longer, so while these are thoughts on suicide, the are not suicidal thoughts. In fact they are thoughts, and the topic is suicide. There is no particular object for it. I'm irritated by thoughts I'm told I should not have. I that's your opinion, great. Then that's your opinion. Keep it that way. I want to sort this out.

When I first heard of this Kevorkian guy the topic was new to me. An advocate for death? Did death need an advocate? It seemed like death was doing pretty well for itself, seemingly having cornered a market for itself. It was unfortunate he looked like Skeletor from the He-Man comic books. I saw him and immediately expected to see all kinds of minion at his command. But Kevorkian's minion seemed nothing like the cartoony demons I knew from TV. They were people who were talking about picking the right to die with dignity. People who knew suffering. Adults who watched their parents die from cancer, or octogenarians ravaged by disease, these were people who just wanted to go gentile into that good night.

That didn't sound like suicide to me. That sounded like dying. People die. This sounded more like mercy killing, you know, the way a vet will put down an animal suffering without end. Was a person choosing the terms upon which they died considered suicide? Suicide sounds like a person with much life to still live deciding they do not want to go on any more. This doesn't seem like suicide. My first thought is a teenager depressed they got dumped by their first great crush and despairs of all life. A tantrum, basically. Depressed and not wanting to live. Those are very different associations to me than those people who are already dying and trying to endure convulsions and bitter throes of death. I can't think of a single person who has a pet and would let it die in such a way.

This topic is confusing to me. Some of it is the ideas themselves, some of it is the wording used to describe those ideas. Suicide: is that actually illegal? It couldn't be, right? I mean what would happen to a person convicted of such a thing? They're dead. I know there are varying theologies regarding this as well, but I am focusing on this life, not the next. If it's not illegal to determine your own death, then how is it illegal to assist someone in doing what they want to do? Aiding and abetting an activity that isn't legal? That's confusing.

I remember hearing someone saying that Kevorkian was a killer, another that he was euthanizing people who still had good living to do. Frankly I can respect those arguments too, except they sound like value judgments made by someone other than the person suffering. These opinions are everywhere, and I'm still trying to comprehend the words they're throwing around. Parties supporting life… parties supporting choice. Apparently calling it death is not appealing. Death is the last active of life. Life's last living moment is death. They are the same damn thing. I want to remember those I love for how they live, but don't want them to suffer if they don't want to.

When you're ready to go, do you want to be able to tell someone one your own terms, or do you want a loved one to have to sort that out for you? My grandmother, whom I've loved and lost to cancer suffered terribly. She was great because she was the intersection of comedy, dignity, and love. A lot going on there. Always a place you wanted to be. I remember her dying, but I wasn't there at the precise moment. I was never told the details. Her suffering was so great and there was nothing they could do. It would have been illegal to medically end her life, so they sedated her and the family decided to stop feeding her. She died shortly after. That's not suicide? No. She didn't do it. Someone assisted not feeding her, just as they had assisted feeding her the day before. That was legal. It's not illegal to not eat.

So if it wasn't suicide, and it couldn't be, since she wasn't conscious, what was it? Murder? Please… This woman was suffering and dying. Not feeding her was legal and she was sedated to not suffer. A physician could not do here what a vet could do for your dog.

If it's legal to not feed those about to die already what exactly is this debate about? Time? Quality of life? Choices? Dignity? I don't see much of any of these things at the end of life. Just a spirit that has grown too big for its own body and it trying break loose from this cocoon to start over. I don't see the debate in any of that.

In the end a life ends and new one begins. The rows of corn are still growing, the treetops are swaying in a light breeze. Cars still roll along. Squirrels peep around trees to see if I'm coming. I don't know this Kevorkian guy. Did he find himself involved in this as I did with a premeditating squirrel? I don't know. In my case, I can't say if the squirrel was depressed, or not taking his meds. It's possible it had been dumped by a lover, or he'd inadvertently busted his nuts. Was it a choice? An accident? I don't know. I just know I assisted in it and felt like the only one on Earth who knew what had happened, or so I thought. Three miles later, on the same road, another squirrel jumped out in front of me and was crushed by the same tire. This time a reddish brown one. Did they communicate? Am I now Skeletor For Squirrels? I don't want that job. I'd rather they picked someone else. Maybe you just don't get to pick some things. Like who's there when its time to decide if you're going to turn off life support. No one calls that murder, or suicide, or assisted suicide. Mostly people don't talk about it. They don't think about it. Bursts of grief interrupted by life's essential distractions.

But it happens. And when it does maybe all I want to know for my own sake, is that someone I care about can mercifully end this life and blossom out into the next. It's not the conversation I hear on the news. I have not interest in new laws. I've got plenty I've not used already, and for that matter I'm surrounded by lives that are not in this quandary. So why have I spent all this time thinking about this? I don't know. Because I can. Because I'm suspicious of every squirrel I now see is a kamikaze. Because I'm not sure if I want to drink the Kool-Aid being served by the media without first checking the label. Because if I'm ever in a position to have to make this decision, maybe I don't want to feel like I dishonored an honorable life. Or maybe I'm just hallucinating these squirrels. That might be better.

Running In Circles

I never really got track. As a kid, in fact I played them all. Had a great time. Running was a requirement for all of them, but track was the weird outlier: It was the only thing you did… the mindless thumping of feet. In high school I remember the basketball coach telling me how it was a good idea to run track to improve my conditioning. It didn't seem like a lot of fun. Running in circles. I did not really want to do it, but I agreed. For the next three months I regretted the decision. I remember dreams about quitting the team and awakening to realize I would not. I gave my word to participate and compete. Its just I had no idea what I'd signed up for.

Basketball involved bursts of running at varying rates for less than an hour. Time outs helped if you were winded. They would substitute someone for you at times. Football was a game played in 30 second intervals with another 30 second huddle. Track was just running. And running. The flapping cadence of feet punctuated by sharp exhalation. And that was it. I hated it.

The workouts seemed impossible at first... 28 miles a week (days of 4,8,4,8,4). The first day I though I would die, until I got to the second day and realized the first day was the short day. At first it was the physical discomfort that I disliked. But that went away after a couple weeks. It was the time alone with my mind that was hard. Country roads with dotted passing lanes crawling by were measurements of progress... I'd count them sometimes, or telephone poles until I got bored and finally looked at what was on my mind. I generally tried to avoid that, but it was impossible after a while. The 28 mile week soon switched with and became a 36 mile week (8,4,8,4,8). It meant an increase in the amount of time my mind wandered… and tried to avoid the things I didn't want to face.

Fears lived there, in the recesses of my mind. Fears of failure, inadequacy, of my best being insufficient, of letting people down. I could avoid these things in days full of homework. Not on the road. The roadwork was the hardest part of track. The conditioning was fine, the thinking was brutal and the track meets were fun. I enjoyed watching my friends compete. They were actually good, in fact there were state champions among them. I wasn't... In fact I was marginal at best but it wasn't why I was there.

My friend Chad was a year younger and was made for track. It was amazing to watch him. He was basically a pair of lungs on legs. Thin, sinewy, short. He ran leaned forward slightly like he was trying not to get blown over backwards. He was a star. There were a lot of people like him there. They all did well. He got leukemia and died, after battling it for a few years. It took his hair and left a pallor of death. It did not take his sense of humor or his determination. He never stopped running. Despite the chemo, the nausea, the weakness, he ran. The day before he died he went out and ran a half mile. It was all he had left. He still reminds me strength has nothing to do with physique. That lovable toothpick had all the might of Atlas.

He was on my mind today as I was on a track again. I forgot the feel of the cushiony asphalt under my feet. I hadn't been on a track since high school... when I mostly saw Chad and the other gazelles pulling away from me as if they had caught a tailwind that I had not.

The track was the lynchpin of the Relay For Life, a cancer fundraiser. The entire town turned out in tents, booths, and displays around the track and for 24 hours people would do nothing but laps around the track. Some ran. Most walked. Families walked together, pushing strollers, holding hands with their kids. Then they stood at some booth where they collected donations. My wife and daughter were at one such booth. My job today was to manage the boys. We walked laps around the track.

It was hard, honestly. I felt like crying about half the time and still have a hard time explaining why. Sometimes there's too much to absorb at once. A million thoughts I could not contain or repress. I'd not thought about Chad in a while. He would be old enough to have had a family of his own now. Kids about my age. Little lungs on legs... Just like their dad, with a sense of humor and a determination that only death itself could take away from him. It's just that those kids do not exist. I miss him. I wish I could meet those kids.

I thought about my grandmother, who died 15 years ago with colon cancer that metastasized and filled her lymph nodes, eventually closing off her air supply and ending her life. The most gracious and loving person I'd ever known, and who maintained humility by exposing herself to a series of hilariously weird accidents: The time she drove the car through the garage... The time she got stuck with one foot on the dock and the other on a boat floating off in the opposite direction. So many stories. So much love… so much fun. Hugs… cookies… love… she had it all. She gave so much that I even overlooked the bad plaid lunchbox in the first grade that got me so much ridicule when everyone else had Batman or The Six Million Dollar Man.

She got the cancer scare and changed her life around. She lost weight, ate right, exercised. She did the chemo. She beat it. She had made it to remission and the second to last scope showed no new tumors. She had a few terrific years before she got the news that it was back, inoperable, and terminal.

I look back and see moments I want back. Do over! I'm taking a mulligan on that one. Bring everyone back and lets try take two, people. Being on the track reminded me of a moment I would rather to forget. Grandma was walking 2 miles every day now that she'd been through the first round of chemo. She was determined to take every advantage of the new lease on life. I'd just finished my first year of track and wanted to not lose the conditioning I'd paid so dearly for over the last several months. I was stupid and arrogant and totally incapable of appreciating what it meant to be her at that moment. I scoffed at her two miles and said I'd run 4 in the time it took her to run two. She took that bet, saying we'd set up a course around the neighborhood that was a two mile lap. I'd go twice, she'd go once. We'd both keep our own time.

She slaughtered me… my ego was in better shape than my cardiovascular system at the moment, it seemed. I talked a big game, but frankly I was not great at the running thing. When I rolled into the driveway, ribs cramping, legs shaking, she was sitting there, looking at her perfectly painted nails, feigning boredom. She whipped me and she knew it. I knew it. I was a heel for trying to flaunt my health and youth. She was fighting cancer and I was talking smack with her?? I am still shamed to this day. Not for losing, but for not taking that same walk with her and holding her hand instead of racing her. You just don't get these moments back. They just stay on, forever as a reminder of why you should never take yourself too seriously when you think you've got it all together.

So it is with humility that I rounded this track holding the hands of my two boys who never knew this great woman who was like a mother to me when my own could not. I saw in the faces of the people that had been there all night that they all had their stories of love and loss because of cancer. Who doesn't know someone who's had cancer? And in the faces of these people I've accused of being Desperate Housewives, of being vapid and materialistic, I saw the same choked expression, like if you talked to them, they might cry. We're just not as different as we'd like to believe. Only the veneer is different. Our tears are the same.

Last month I was told by a doctor I "probably didn't have cancer." I pointed out with great concern that 'probably' is not 'definitely'. He agreed, and arranged tests to provide definitive resolution. I tried to be ok. I was not ok. I was very worried. Scared. My luck in being a statistical outlier is renown. I didn't want to break through the odds of 'probably not'. A week after the tests, I found out for sure that I didn't.

I don't mention this for support sympathy. If I wanted it, I would have posted the news a month ago and begged for comfort. I mention this now because I was on the same track as cancer survivors who got that same conversation with their doctor except a week later their news was much worse. And both the survivors and I were on the track while even more people got the same conversation: "It could be cancer", and it was, and they are now gone. I have nothing to complain about. I am blessed beyond my own understanding, despite my every effort to assume I am the reason for my great luck.

It's at times like this I am knocked down a notch. I was today. The Relay For Life was nearly finished. The event closed 24 hours after starting with cancer survivors making one last lap. It was funny looking through that group of strangers, wondering if I'd see someone I knew. I didn't. Just people whose trip I've been on. The grandmother walking with her grandkids… the teenage girl in the purple wig surrounded by friends and family wearing t-shirts with her picture on it. I've been in those groups. I wished them luck. They started out on their lap and my wife asked me to track down my daughter and her friends to help with some tear-down functions.

Mindlessly I start walking along the track, like I had done the entire day. No one was on it because it seemed the event was over, or at least focused on the cancer survivors at the other end of the track. I'm not sure what happened. Maybe I walked faster than I thought… or people just saw this guy, alone, walking on the track behind this group of other people who were cancer survivors. For whatever reason, people were clapping and cheering me on as I walked by. There are no words for the shame I felt, after realizing what was happening. They thought I was one of them. When I started walking, no one was on the track at all… not even along the sides. Into the third turn, there were people lining each side suddenly and they we clapping and saying "way to go!". I saw my daughter between the third and fourth turn and we cut through the infield to get back to my wife.

The guy afraid he had cancer and didn't, got praise for strength he didn't have to find. It's really hard to explain to the people who are clapping why they shouldn't. Waving them off makes you seem demure and magnanimous. Humble. They're not looking for mistaken identities. Sometimes, when life comes like this I wonder if I will ever learn from it. Looking back, I hope I did. I know this much: I didn't race my daughter back to the tent. We took our time, held hands and walked.

Editor's Note: I wrote this at the beginning of a long series of medical tests to find out what was wrong. It took a while and while cancer was not the first item they considered, all the others fell off the list until it was cancer or GERD. How could it be something so simple? It was. In the end, there was surgery to repair a stomach valve and the rest has been history. No cancer. Unlike all those people who walked that circle, it was not a burden I had to carry. The weight of its shadow was enough.

I Am Not Rosa Parks... But Don't Tell Me Where To Sit

I got a form to volunteer at my son's school and was so excited to participate. Guest reader. It's so fun. Snacks… juice… Green Eggs And Ham… what could be more fun than circle time? With gusto I snatched up the form and filled it out. The basics. It seems that every form asks the same thing, but no sooner than I considered this thought, I came to a line I've not seen before: race. Race? Are you kidding me? I need to tell you my race to read? Ridiculous. So considering it insignificant, I put 'N/A' in the box, and continued on with name, driver's license number, address, etc. The form left for school the following morning and I didn't give it a second thought.

Until it returned. With a note.

"Please COMPLETE, tx"

Circled in red and twice underlined, I could see N/A was not going to be sufficient. Man… I really don't want to deal with this. I want to read to my son and be a hero for handing out goldfish crackers and reading in funny voices. So I fumed. I talked to my wife. I talked to my mother. Mom suggested sending the form back with 'Human' instead. I liked that, but feared it would just prolong this inevitable trouble that was coming.

Ok… quick intermission. Bathroom breaks. Sodas. Smoke'em if you got'em. While you are taking a moment to relax, consider this funny quote I saw somewhere:

"There are two kinds of people: the kind that think there are two kinds of people and everyone else."

That cracks me up. I am not sure what it is exactly… maybe it's the idea of we're infinitely similar. Capable of the same thoughts, both good and bad, words, and deeds. Only our actions distinguish us. Our choices.

So… I know these people at the school. They're good people. They care about the job they do. Individuals and as a group, they care. So, I may not always agree with their choices, but I am always sure they are acting in what they consider the best interest of the kids. I didn't want to offend anyone, yet I AM offended. My race? None of your business. So I sent a letter, and copied the principal, cringing all the while as I feared the firestorm I would bring on a good person.

The letter goes as follows:

[DATE]

[Name of Recipient], Security [Censored Name] School [Address] [State, ZIP]

Dear [Recipient]

One month ago I submitted a Volunteer Consent Form to Crestwood Elementary in order to have the opportunity to read to my son in his first grade class. The very fact that you have a screening process in place is of comfort to me as a parent. I of course commenced to filling out the form in every detail… except one.

Your form asks me to disclose my race. I declined, rather opting to fill the appropriate space as N/A. As a result, I at this very moment looking at the form I filled out one month ago. Your note states to "complete + return […] Thanks" and a red circle and two red lines draw attention to the form in the area of race.

I wish to be clear: I am interested in participating in volunteer activities at the school. I have provided my State of [omitted] Driver's License number for the purpose of verifying my sterling background. I do not see this as the appropriate venue to discuss the profiling of parent-volunteers in your school. If I am not guilty of any offense described in:

· Section 1539(a)(1) and (b)(2) of the [state] School Code

· Section 7410 of Public Health Code

· Act 368 of the Public Acts of 1978 (being Sections 333.7410 and 333.7416 of the [State} Compiled Laws)

then according to the rules of your process, I fit the criteria necessary to read Green Eggs And Ham. Race is not listed as disqualifying criteria from participation. Should that be the case, I do not find offense, and intend none, in refusing to disclose this information. You will see, with the exception of a speeding ticket a few years ago, there are no offenses of any kind.

It may be of some reasonable discussion for another time to examine the very purpose of including a line indicating 'race'. I do not see this as an appropriate forum, and my qualifications do not recommend my service to this cause, however I trust you will do all diligence in assessing the matter. My wish is merely to read to my son in his class, not debate the definitions of regarding inhabitants of the Caucus Mountains.

With all due respect,

[My Name}

cc: [Principal]

In conversations with the school, both in the superintendent's office and the principal at my son's school, they were surprised such a requirement was on the form. They apologized for the inconvenience and said it was not the intent. They wanted only to make sure they were not permitting pedophiles and predators to be with the kids. I respected that, and feeling like I changed the world a tiny bit, I basked in my little accomplishment.

Until the voicemail message came.

The school's security office was insistent that I had to fill out the form. Not optional. It is my choice to volunteer. Its fine if I don't. Fill it out, or don't fill it out. Its up to me. They are following the rules as set forth by the state. They have not choice. Take it up with them. So I did. This weekend, I sent this to the office of the State Police, division of criminal background verification:

[Department],

Can you help me understand the requirement for fields on the criminal background check? I am a parent of a first grader and in order to volunteer at the school to read to my child at school I've been asked to fill out a criminal background check form. I was more than happy to comply. I filled out the form in every detail, until it asked me for my race. I frankly am not interested in offering the information. It's not a requirement for my ability to read, or volunteer in any capacity. Considering the composition of our school, I'd rather not share. Yet, they tell me that I must. In fact, if I do not comply with this disclosure, I am not allowed to be a volunteer, even if I do not have a criminal history. I do not have a criminal history.

So... here's my question for you: why must you have my race if I can provide you my [State] driver's license or SSN? Granted, I understand that some people have common names, but how many people have my SSN or DL? No one. They are unique. Key data. Not race. Race? I get that it might matter if you've got an APB out for someone and are trying to visually differentiate between potential suspects, but this is nothing at all like that. I cannot see the logic in this. Can you explain why this is permitted?

The implications of this field being a *required* field are:

• Schools must ask volunteers their race before agreeing to let them participate.
• Churches must discriminate based on race in order to have volunteers in their nurseries.
• Employers must ask for the race of their applicants before hiring them if a criminal background check is required.

If we are supposed to be moving to a place in our society where race is not an issue, this certainly doesn't help take the issue out of the conversation. These groups are required to get this or they must tell people, as I have been told, that I am not allowed to participate. Does the organization look as if race matters to them? Yes. Does it look like the State cares what your race is? Yes.

I understand that our government is a reflection of the involved people in our society; a reflection of their votes of confidence. And since I don't care what my race is, and most I know don't care, why is this being brought up? Again, I know when visual search is required, skin tone might matter, however, not when unique data sources are available. I am asking you for clarification because this seems so logical to me, I must be missing something. You, being involved on a day to day basis in this operation, perhaps can explain this to me.

I eagerly await your response,

With all respect,

[me]

UGH!!! Am I crazy? I am the only person who seems to notice this? Thinks its odd? Sure I could go off and... well I would if I had the energy... on this race baloney. Ok. Maybe just a shortlist:

• 'White' is a color... not a race. Ditto for 'black'.
• If white and black are 'races' then why not 'brown'? Most are...
• Seriously... who lives on the Caucus Mountains?
• Are the inhabitants of the island of Lesbos ALL Lesbians? (ok... so that's digressing a bit... not really so much about race as label)
• If you're 'hispanic' AND 'black', then what do you do?
• If you're 'black' and don't look 'black', are you 'black'? How do you determine? Is there an empirical test? Luminocity? SPF? Melanin count?

I am so tired of this labeling. I feel like I am always caught up in it. My eyes... they're not really brown. Sort of green. But brown. I had to pick an eye color while filling out the driver's license at the secretary of state. I wrote in 'Khaki'. Seemed a reasonable compromise. Apparently, they're more interested in compliance than accuracy. I had to pick green or brown. I went with brown. You at least know the real truth.

So I wait to find out what my state tells me about their requirement to know my race in before I can read Green Eggs and Ham to my son in his school. I am not trying to make an issue of this. I just want to participate... without the profiling. So when the reply comes, asking me again if I'll just make it easier for everyone and just fill out the form like everyone else, my reply will be:

Not in a plane,

Not on a trane,

Not in a box

Not with a fox...

Anniversal Thought

(repost from Oct0ber 2006)

Anniversal Thought

My Anniversary was Monday. I wrote this in my journal... not really intending to send it to anyone. But finishing as much as I could before work called for me, I decided to send it along to my wife, with a note telling her that "this was in my journal today, I thought you might want to know". She thought I meant "BLOG". I meant journal. Diary. She posted it.

Oops. Ok... for a second that I kinda had that awkward-forgot-to-put-on-my-pants-before-leaving-the-house look, but then I realized it was just not a big deal. It was for her... and if other people care to know, then so what? I don't. So in the spirit of glasnost, I am sharing it with you here: regard it as you wish, if at all:

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

At a glance little has changed from any other day. A seemingly familiar moment. The van hums along, the rotary of the tires on the road, the inane babble of radio sports guys, boxes shifting in the back of a cluttered minivan. These fall trees bend over the road in their final burst of color before withering away. An expressway looms out there somewhere to lead me to my next appointed task.

I've been here before. So many days that seemed like this with swirls of coffee poking through my travel mug, but not so. The calendar reminds me I have been married 13 years today. Thirteen years. How can that be? Considering my numerous identity changes via serial maternal remarriage, I cannot imagine this fidelity exists. Yet here it is.

Hindsight has shown me a pattern of fearful protection and estrangement that at a glance looks a lot like me: aloof, thoughtful, quiet, alone. I know many, and befriend few. Its not about trust... I trust we all fit a role when the circumstances fit. No... Its more about something else. I am not sure what exactly to call it. Acceptance? I don't want anyone's. But, in my reclusive innerspace I've felt alone. For so, so long. Its easy to find a rut, to avoid the awareness of change and growth... These routines help. The radio and the swirling wisps of coffee steam are a great sedative tonic, and with them, I could lose myself for years without paying not to the precious moment that is here. The calendar reminds me.

The leaves looked just like this 17 years ago as I walked to a dorm with my friend Garry. He knew some people. I went along with a few guys. I am not sure if I said anything, but I was supposed to interview sorority girls as part of pledging my fraternity. I remember seeing her for the first time and she was so beautiful. Luminous eyes that looked right through me, past the thin veneer I tried to put up and into a place I let know one see. It was hard to breathe. The moment passed. I breathed a sigh of relief. It was weird. I'm not sure she even noticed me, but I felt so exposed. I didn't try to talk to her afterward. She was beautiful. Stunning. She had certainly a long line of better men awaiting a chance to see her. Honestly, I am not sure I liked the idea of feeling so vulnerable.

Yet I did. After the shock wore off, I thought about it. I'd felt so alone. That no one would want to be in that place with me. Someone would see me, my need: see me and go. That was a pain I didn't want to think about. There were other things to think about... An education. A career. So I found a routine... A distraction... Time went by.

The following March, I stood in the foyer of the fraternity house watching drunk people. Somehow I got stuck being the Safe-Ride on St. Patrick's Day. Not that I was into green. I hated the idea of anyone telling me what to do. Wear green? Whatever. I probably looked more like Johnny Cash than St. Patrick. It was hard to hear... Hard to mingle with drunks who, despite their oblivion smell like cigarettes and beer to those with any remaining sense. Honestly... I was miserable. My heart was as dark as my clothing.

And then I saw her again. She was dressed like a Leprachaun! And she had a friend with her... She mingled, danced, hugged people and then walked up to me. She said something. I'm sure I couldn't understand... The noise from the music, or my chest pounding... She and her friend made smalltalk. I tried not to look at Lisa. When my eyes met hers I felt a tightness in my chest. Tingling. Is that what they mean by electricity? The night was a blur. She was also a safe-ride. Weird. What are the odds. We talked. She was interested in talking to me. I wanted to take her up into my arms and kiss her... But couldn't. She needed a ride to her dorm at night's end. I was happy to oblige. She stood there waiting for me as I got out of the car. I wanted to kiss her. I wanted to kiss her, I wanted to kiss her. She looked at me. I wanted to kiss her. I gave her a hug.

I am so lame.

Lame.
Lame.
Lame

She dated me! I fell in love with her. Did I? Fall? I was afraid of how much I felt for her. Worried about being seen for the person that I am and unwanted. And how could she possibly want me? Why me? It could be anyone. It was so hard to imagine. But she was there. She was with me as the season passed in school, and I felt a growing comfort in being loved despite my fears... And growing routine.

I worried about my career. What I'd be... If I'd be any good. I wanted to help people. Touch lives. Felt like I had no choice but what I should do with my career. My heart was not in it. I was afraid marriage would ruin my postgrad work... Lack of attention to devote. Fear of two kinds of failure. Simultaneously. But I felt love. And a sense that it was unsure what would come next.

I asked her to marry me. She said yes. I have never been more grateful.

I graduated. We married shortly thereafter. It was a cold overcast day, like this one. It rained slightly. The sky brooded and loosed short tantrums of rain. I waited for someone to pick me up. We were late. The cumberbuns did not match. Someone ran to get it fixed. I stood in the middle of a two lane street, no cars to be seen anywhere. Just a soft misting rain. Leaves in full color stretching over the street, collecting in harvest toned piles along the curb.

I was nervous.

The ceremony began. I was so nervous. She walked down the aisle... Those eyes. She was so beautiful. So happy. And she looked into my eyes. I felt tears coming. I tried to look away. Think about something else. But I couldn't. I wanted to feel it all. The everything. It was so hard to taken in. I felt overwhelmed. My lungs seemed too small. I tried to breathe.

The minister asked me to repeat after him. I could barely speak. I felt an infinity of tears welling up inside of me, the release of a lifetime of fear, of not being wanted, loved, accepted. I tried to speak clearly. My words work hoarse. A scant whisper.

She held my hand and looked into me and smiled. I will never forget that gaze. Then she looked right at me and said her vow, to love me, in sickness and health, for richer and poorer, and forsaking all others said she'd love me til death parted us... Thirteen years ago.

And so much has changed. And not changed. I'm more honest now about my fears, but probably don't show it any better. I still reach for defensive rountines full of nothingness... Television, work, excercise, food. But I've been able to see through it all that she loves me. She loves so freely. She is more beautiful than ever. And I've learned so much about life because of her. I've seen love. God can be no more gracious.

But marriage hasn't made me a perfect man. No... I still wonder how she could love me... what it is that I do for her. I still feel unworthy of the gift I've been given. I am grateful. Humbled. Over time I've seen conflicts and traumas, and she loves me. I see it. Feel it. We've made kids together that share in her gifts. Beautiful people.

I feel so much for her; a love that is comfortable and uncomfortable. The routines feel good until they become routine... And then she changes. Another facet turn of a priceless gem. She hates routine... And I see than I can choose to curmudgeon, or drink deeply from her cup of life. A drink that is different every minute.

So at a glance, the rain, the coffee... The radio guy. Its all like every other moment. A reminder on the calendar asks me to make this real. To see it for what it is. And I do... And its so beautiful, I feel so happy... I feel tears welling in my eyes. And a doctor's office waits for me. I have to think about them now... Or I'll be a mess.

Hi! I Am Self Absorbed!

How are you?

Really... I mean that.

How ARE you? Sometimes people say that and don't really want to know. This is makes for terrific awkwardness, as no one wants to suddenly realize that the painful rectal itch they've just mentioned was not well received in conversation. The inability to read the intent of the inquiring conversant makes for blithe, meaningless words. In order to play it safe, you might just posture and make say all sorts of foolishness, like:

• Good: Are you that ready to break into that level of qualitative assessment so early? Seems a bit premature that such an ejaculation, but I wouldn't presume to know. I mean really... Goodness? Proclaiming it outright, just like that? Summarily? Thats a little ballsy in my book. This answer from an unsuspecting miscreant is the worst... I suddenly am torn between conversing and investigating this alleged 'Goodness'.
• Fine: Another in similar context. You're 'fine'. Ok... What would you say to me assessing you as honestly a bit coarse? I mean if you drink beer out of a can, its it ever possible to be fine? Or a think of delicacy for that matter... Seriously? Don't make me talk about finery. Don't do it. The only saving grace of this word is the potential to mean 'unique'... 'rare'. That I would buy... If only the other person did too. That could make me digress on my initial digression and move into the area of equality and the misuse of that word. A load of populist savagery that one has become... But perhaps we'll tackle that another day.
• "Ok": I'm sorry... THIS IS NOT A WORD! Its origins are suspect to begin with. Its a statement of mediocrity. Ambivalence, or worst; carelessness. Burping in response to the question ("How are you") has more real emotional intent. Don't give a damn? Tell'em you're ok, ok?
• Well: This is my favorite, not simply because it is grammatically correct, but because of its tremendous flexibility. A sea of ambiguity wherein you are free to work:
  • Well...: The basic statement of health.
  • wHell! ...: There is a story coming.
  • -Whale? ...: You're just not sure.
  • weLL? ..: I guess this is it... Resigned.

In general, 'well' has the utility of 'set' right away in the beginning of conversation. Versatile... noncommital... ambiguous. Love that. And getting back to the point before I actually made a point, to the first digression, you don't really care... Do you?

Please don't take this the wrong way. But of the percentage of encounters wherein you actually inquire as to the wellbeing of the other, how often do you mean it? You know... That feeling of excitement: "Hey! How ARE you?" Most of the time its the same tone reserved for hotel conventions and the social time allotted to 'mixing'. "How are you?" is a lifeless, tired thing for me in that place. I'm not sure I want to know... Less sure I want to ask... And I sound like a petulent toddler being told to say he's sorry.

And so, perhaps this is nearing the heart of the matter: care. It should seem impolite to not inquire into the wellbeing of someone you happen upon. Yet is it less impolite to not care and still ask?

Why should you? There is an infinity of things upon which to engage in this moment. Places to go, things to do, stuff to remember. Maybe that's max capacity, or you think it is... Because its the realm of the known? Because it cannot be fully attended? Because your own navel seems so much more appealing?

No. That just feels wrong. So why not care? What is the risk? That you may see your humanity in that person loathed in a glance? Because the stunning exterior of that person is shiny like their hairspray and it makes you wonder about what you are not? Because you don't want to be summarily rejected? Because you don't want to see the paltry differences separating you from me. You and I... I realize I am talking about me here. Not you... Sort of a quaint irony.

I am left to revisit a conversation with my own child about food. My daughter didn't want to try something new because she didn't know what it would be like. Would she like it? Would she hate it? Rather than risk the best, she accepted the worst: nothing. I pointed out how she seemed eager enough to get off of soy formula as a baby in exchange for real food. And if she didn't care to know, she never would.

And looking back at these words, I can only laugh. There's something funny about this to me. Maybe that I orginally started to a letter to a friend and these words turned into a rediculous monologue. Consider this in a letter... now you know what its like to get one from me. I laughed, because I see frankly I do this a lot in a certain grade of company. Not intimate acquaintance... but people I like. In fact I do it all the time... I think I made a career of it... this nervous tick. Monologuing. Distracting. Amusing. Irritating. To be honest, I always thought it was about someone other than me. Its not. Its all about me. I guess I am just self absorbed. We probably have a lot in common...

So...

How are you?

I'm well.

An Eye For An Eye Making The World Blind

Morning came well before I was ready for it. A combination of meds seemed to keep me awake well beyond the limits of my usual sleep pattern, but not for my kids! No, they were bounding about when I awoke. I could hear them doing lord-knows-what in the floors below. So, glancing at my wife's gracefully somnilent form, I got up staggered to the shower.

The shower's such a handy thing... a malodorous cure and a relaxing place to think. So I did. First I thought "hey! who used all the shampoo" but then as the monotony of the routine took over, I started to think about other things. There's a cease-fire underway tomorrow. Israel will stop bombing what's left of Lebanon. And in an effort to get ready for the hiatus, there's a push to destroy as much as possible. There is a sadness about this suffering that will not rinse away. In that moment hunting about for some other shampoo, I'm thinking about the fact that some evil genius has developed a formulation that will blow up airplanes and moisturize dry and damaged hair. Impossible to imagine.

Mindlessly I get out of the shower and fumble about the routine of getting dried off and dressed. From the vent at my feet I can hear the gleeful shriek of my middle child and someone else making an animal sound. There is no intermediate volume in my home, just on and off. And thinking they'll need food or find it themselves, I hurry. Brushing my hair and teeth at the same time. Grabbing the aerosol deodorant as I look about for my pda. Suddenly my eyes are on fire. I'd sprayed the deodorant, but in my haste, did not look to see in which direction. A blast of butane propelled Cool Fusion is melting my eyeballs! Reaching for the sink I rinse. It burns. I repeat. Still burns. For some reason this stuff seems to repel water, oh... right. Its a deodorant.

Its a DEODORANT! I use soap to wash that off in the shower!! So blindly I search for the soap, lather, and I wash only to realize I AM PUTTING SOAP IN MY EYES! Before my eyes burned, but they at least smelled good. Now they were soapy and no matter how much I rinsed, I could not seem to get all of it off. Ouch! And however rediculous it sounds, when you NEED to rinse your eyes, you can't. They don't want to open. I tried and tried and the kept closing. So I'd fill my hands with water, hold it to my eyes, and open and close and the water poured from the spaces between my fingers. It wasn't working, but I was not going to try conditioner, no matter how dry my eyes were.

My ankles were aware of the nubby cotton towel and with a blind swoop, grabbed and dabbed. And dabbed. And blinked, waiting for the pain fade, then chuckled. My mind, vastly contemplating fighting and death and airport security and happy semi-ferrel kids, had not considered the many small and essential tokens in that present moment. I wasn't paying attention, and the chuckle was from imagining what my mother would say if I'd done that as a kid. Frankly, it would be more of a look than a word from her; something mixed between pity and wonder for this son of hers who is alternately bright and retarded.

So I dressed in about 200 blinks, found my groggy wife and kissed her a few times (I wonder if she could smell the deodorant on my face... she's like a hound dog that way... *gasp*... did I call my wife a dog? This is obviously untrue, but I begin to digress...) and went downstairs where my happy kids ate fruit and cereal and watched Scooby Doo cartoons.

Notes From A Summer Day, Long Past

Summertime!

Its warm. I got up late... something like 10:30 and the kids were willing around patiently eating bananas as their babysitter, Spongebob, taught them how to use sentence enhancers. It was 3am by the time the last guest left last night.

Kids wanted to get out of the house... I wanted a shower. We compromised. I cleaned up and they waited. Mom had a migrane. I could feel it then... the cool air blowing in off the late was already pretty warm. It was going to be hot.

The idea of being outnumbered at breakfast 3:1 seemed insanity to my lovely wife. I suppose it is. But we went anyway and caught a break. They were angels.

We had a blast... Bought some stuff to fix the sprinkler system and more propane for the tank. Boring to kids. The highlight of the trip was looking at toilets at Lowes... cracks me up. Three kids sitting on the toilets while a clerk watches nervously to see if they're actually using it.

I stopped and treated them to ice cream. They've been great. Then it was a mess... and the youngest fouled his pullup (cannot wait til that is over) and is now freeballing at the park where I jot this note. We found a creek as we walked here and climbed around under the bridge and sat along the banks... splashing our feet. Its hot, maybe 90 and the water felt great.

There is a moment there in the creek, when all you can see are the rocky banks and water creeping over, trees leaning in toward this hidden, babbling secret. Blue jays hopped from branch to branch and butterflies fluttered on the bank. One flew up to Noah, my four year old. He screamed and ran in a frenzy toward the car with the tiny yellow lepidoptera behind him, following lazily. I tried so hard not to laugh.

So now I sit under this elm tree and the kids have come back... "We're boiling hot dad, can we play in the river?" Sure. How can I resist? This is the best of times. Welcome to summer.

Can You Control Immigration?

Can you control migration? At first glance I didn't see anyone checking IDs on geese coming and going from Canada. How come they can come over with the Avian flu and my wife's great-great grandmother was not allowed to come to America because she had dementia. That's not right. No one was in danger of catching Mad Italian Disease, she was just old and forgetful. Bird flu? Could be contagious. So you're saying perhaps that the geese aren't human? Hmmm. That's a good point. But the people in charge of 'controlling' the migration of people refer to the unwelcome guest as 'aliens'. Not particularly human either. I make a weak and silly argument here, but only because I find this premise weak and silly.

I do not believe you can control the migration of people, or anything, for that matter when they feel the need to be there. Who assumed this was possible? Based on what experience? As I recall, a long time ago, before we called it America, there were people who lived here. Poor guys. First we called them Indians because like fools our forbearers thought they found India when they got here. Then we felt guilty and called them 'natives'. Either way, they were here first. They witnessed the rampant migration of this pale-skinned pestilence that defiled so much of what they found sacred. Ask them how controlling illegal immigration went. Trail of Tears, anyone?

The question that I ask is this: Can you deny something's will to promote its best interest? Sure you can try, but can you do it? The United States has had a policy on immigration for years. Law. They didn't want blacks unless they were slaves. They didn't want 'undesirable' ethnicities. The Chinese that built the railway system in our nation predated this flap over Mexico by at least 100 years. Immigration opened to certain 'kinds' of people over time, but there were rules to prevent too many of one type from infiltrating the culture. That is the foolishness to which I refer.

In this country, we all came from somewhere else. Legal or not, someone was willing to bet their livelihood, and perhaps their very life on the odds of a better future here. Can you stop that any more than you can stop osmosis? And how much energy do you want to put into preventing people from being your neighbor? When I think about the compelling need to find a better life, about the hardship of leaving everything you've ever known, I would not listen to a bureaucrat deciding they couldn't allow any more of my kind. I'd be here anyway. I would about as well as the colony at Roanoke did. Damn the torpedoes. Try to prevent me from living what I think is a better life for me and I will make it my life's work to be here. And that of my children. Arrest me. Deport me. I will return. Beat me. Kill me. I will be laid to rest in the land of my desire. You cannot legislate my will to live.

Jesus Had A Hot Ass!

Mark 11:1-7

And when they drew near to Jerusalem, to Beth'phage and Bethany, at the Mount of Olives, he sent two of his disciples, 2: and said to them, "Go into the village opposite you, and immediately as you enter it you will find a colt tied, on which no one has ever sat; untie it and bring it. 3: If any one says to you, `Why are you doing this?' say, `The Lord has need of it and will send it back here immediately.'" 4: And they went away, and found a colt tied at the door out in the open street; and they untied it. 5: And those who stood there said to them, "What are you doing, untying the colt?" 6: And they told them what Jesus had said; and they let them go. 7: And they brought the colt to Jesus, and threw their garments on it; and he sat upon it.

Sitting in church yesterday was a strange experience. For years I've attended. As long as I can remember and I know the stories well. I've read most of them, been in group discussions about them, and read opinions about what other people thought they meant. That was good enough for me for a long time. Perhaps I was busy frying other fish. But recently something has begun to change in the way I hear things. I seem to be actually listening. I guess I always have listened, but listening and thinking perhaps is a better way to put it. And now the church is a different place. Not a bad one by any means; it is a better representation of what people can do when they are not focused so selfishly on themselves... but...

I just don't like being told what to do. That's it. Call me stubborn. I'd be the guy going to war over the price of tea. My grandfather called these molehills 'the mountain I was prepared to die on' with his best middle eastern flourish. And I like church, like the Bible (as entertaining literature), and think some of the philosophy is good. But I am not buying what I am told without some critical reflection. Call me Thomas.

It started with the idea some months ago that I wasn't actually a sinner. That I am not, in fact imperfect. We are all, in fact perfect. I blogged on it somewhere in greater detail but the idea in summary is that if we are truly like snowflakes, one of a kind, then we are a statistical sample of one, which by definition is the standard of observation... or perfect. Or perhaps, religiously, if you believe in a divine god why would it create imperfect creations in its own image? That seems wholly illogical. And literalists often mention Eden, which is a great story. One of my favorites about human nature. It really is the story of all of us... amazing considering how very old it is. Our nature is essentially unchanged after all that time. But were it real, that an all powerful god, a creator who could create a universe in a week, could not adequately protect a fruit tree? That is simply not possible. Since this time, the liturgy has taken on a new meaning. The stories are seemingly new again, which is actually nice. Refreshing, even.

But yesterday Jesus stole a donkey. I have never seen until know, but I totally get it. He was running a scam. And its a funny one. No one was hurt. The hot 'wheels' were apparently returned later, but Jesus told two of the disciples (whose names Mark omits to hide the crime ;) to basically steal a ride. Its not uncommon to park on the edge of town as it kept the smell down and I could imagine them being conveniently located on the outskirts. Two strange men coming up and telling them their lord had need of the animal and would bring it right back would not be odd sounding to men charged with livery. All sorts of lords rode through and rarely got their own steed. Why would this be any different? He stole the mule. That ass he was riding on was hot!

I think that is hilarious! It certainly takes nothing away from other good things he did. In fact, I'd like to look more carefully through the Gospels again. Perhaps some find it sacrilege. We all are entitled to an opinion on the subject. This is mine. It makes me smile. Religion needs a better sense of humor. I think I like this guy more and more.

Hate Mail To The Wall Street Journal Regarding Pharmaceutical Coverage

(reposted from 3/2006)

This story ran in the Wall Street Journal yesterday and was forwarded to me by a relative. I read it and was really angry. Angry because they spoke to me like I was an idiot, unable to decide what I needed for myself, angry because they made casual assumptions about an industry that saves lives, and because there was no actual reporting. No investigation. No verification. And it ran on page one.

So before I go off the deep end, I will admit that I am a drug rep. Sure, its an easy job to poke fun at. People do all the time. I don't mind. My work is helpful and I see the impact on the community in which I live. But don't take my word for it. Read the story. Read my response to the editor. What do you think?

PAGE ONE

Negative Advertising
As Drug Bill Soars,
Some Doctors Get
An 'Unsales' Pitch

By SCOTT HENSLEY
March 13, 2006; Page A1

PHILADELPHIA -- Like salespeople for pharmaceutical companies, Kristen Nocco shows up in doctors' offices with slick brochures, well-rehearsed talking points and the budget to buy lunch.

But Ms. Nocco's goal is the opposite of the company people: She wants doctors to consider alternatives to expensive brand-name drugs.

Ms. Nocco, who used to be an Eli Lilly & Co. saleswoman, is part of an "unsales" team funded by the state of Pennsylvania. Its message is honed by Harvard University professors who say they're trying to help doctors make decisions grounded in scientific evidence instead of company marketing. Many of the approaches Ms. Nocco advocates -- such as cheap generic drugs and lifestyle changes -- would cost less, too. Some of her talking points take on top-selling drugs such as AstraZeneca PLC's Nexium for heartburn and Pfizer Inc.'s Celebrex for arthritis pain.

The effort comes as states and employers are reeling from ever-higher bills for prescription drugs. Pennsylvania alone spends about $3 billion a year on drugs for state employees, poor people on Medicaid and elderly people eligible for a generous drug-assistance program.

Pharmaceutical companies go to great effort to ensure that doctors think of brand-name products when they pull out their prescription pads. While the most visible part of that effort is a barrage of television ads, companies spend more money addressing doctors directly. Makers of brand-name drugs employ more than 90,000 salespeople in the U.S. at a cost of more than $12 billion a year, according to Amundsen Group, an industry consulting firm.

These "detailers," so called because they can recite drug facts from memory, crowd into doctors' offices, handing out pens and notepads emblazoned with brand logos and hoping to corner the doctors for a minute or two to deliver a sales pitch. Companies track doctors' habits by purchasing data collected when pharmacies fill prescriptions. A company knows which doctors are friendliest toward its drugs -- and which salespeople are the most effective.

Now a wave of generic alternatives to some of the nation's best-selling drugs is sweeping into pharmacies as old patents expire. Generic copies of Merck & Co.'s blockbuster cholesterol drug Zocor will go on sale in June and could be prescribed in place of Pfizer's branded drug, Lipitor, the industry's No. 1 seller with 2005 U.S. sales of $7.4 billion. But generic companies don't have huge sales forces behind their products.

That's one reason some organizations are fielding their own representatives to make sure the new generics and other alternatives to brand-name drugs are getting used. At Kaiser Permanente, the big California health-maintenance organization, one part of a broad doctor-education program looks for doctors who seem to be overprescribing or underprescribing certain pills. Kaiser then sends pharmacists or senior doctors to advise these outliers.

Medco Health Solutions Inc., which manages drug benefits for large employers, sends pharmacists to encourage doctors to use generics. Governments in Australia, Canada and the United Kingdom also seek to educate doctors in their own offices.

Ken Johnson, a spokesman for the drug trade group PhRMA, said in a statement that the industry encourages doctors to study a variety of information. But he said "it would be a big mistake to discount or ignore information provided by sales representatives who work for the companies that spend 10 to 15 years developing each new drug." Companies "have the most information about new treatments," he said.

'Academic Detailing'

At Harvard, Jerry Avorn, a professor of medicine, has been a pioneer in what is called "academic detailing." He says the goal is to use industry sales techniques -- such as boiling down material to a few bullet points -- to deliver a message based on evidence about what works best.

Thomas Snedden, who runs the Pennsylvania Department of Aging's drug-assistance program, called on Dr. Avorn when he wanted to counterbalance brand-name marketing. The department, via a contractor, agreed to pay a foundation led by Dr. Avorn $3 million over three years to put an "unsales" force in the field.

Pennsylvania has long tried to influence prescribing by doctors in the state. In the early 1990s, Mr. Snedden's department took advantage of computerized ordering systems at pharmacies to block state payments for Halcion, a sleeping pill then linked to violent agitation especially in the elderly. Worried that doctors were ignoring heightened warnings, the state started rejecting prescription claims for Halcion. Prescriptions dropped 95% in a month, Mr. Snedden says.

Mr. Snedden acknowledges that overriding prescriptions at the pharmacy isn't popular with doctors or patients. "We're trying to go directly to the physicians, instead of the pharmacists, and have a dialogue with them about prescribing practices that we think should be corrected," he says.

That's where Ms. Nocco, a 37-year-old pharmacist, and her seven colleagues come in. Their goal is to get busy doctors to set aside time to hear a presentation. Since September, the Pennsylvania unsales representatives have made contact with doctors about 1,500 times and conducted more than 400 educational meetings.

One morning, Ms. Nocco walked into a doctor's office in the Olney neighborhood of North Philadelphia. Like drug companies, Dr. Avorn's organization had done its research and knew the doctor was a heavy prescriber of drugs to the elderly. Ms. Nocco found a waiting room packed with patients. Two drug-company representatives stood between her and the receptionist's desk. She turned on her heels and hustled back to the parking lot, figuring she might have better luck at the next office on her list.

"Having failed so many times, it doesn't bother me anymore," she said. She was in a hurry to squeeze in one more appointment before a lunch meeting nearby that took weeks to set up.

In the beige Mazda minivan that doubles as family taxi and mobile office, Ms. Nocco pulled out a sheaf of maps and driving directions she had printed from the Internet. She lives in Philadelphia's Center City with her husband and two children and is still learning her way to the 75 doctors in her territory.

Twenty minutes later, she arrived at the next stop and lucked out. The doctor overheard her explaining the program to his receptionist, put aside a patient's file and invited Ms. Nocco inside for a two-minute chat. He asked her to call later to schedule a longer appointment.

Though Ms. Nocco believes she carries a more enlightened message than her corporate counterparts, she faces the same barriers to getting in the door. "Until you prove yourself, they're going to treat you like a drug rep because you are," she says. "You're asking for the same thing: their time."

Unlike company representatives, she doesn't have any coffee mugs, clipboards or other logo-festooned items to give to doctors or their staff. To break the ice, she uses her one advantage: her link to Harvard and Dr. Avorn. She carries a letter of introduction from the professor and tells doctors they can have a free copy of his book on the drug industry if they listen to her spiel. Or they can choose from two general-interest medical books by Harvard doctors.

Also, Harvard has certified the content of her talks and brochures as educational. Doctors who listen to the material and pass a short quiz receive continuing-medical-education credits, which many of them need to maintain their professional certification.

Dr. Avorn is confident his team can get traction despite being outnumbered. "Doctors know when they're being sold a bill of goods, and they know when they're getting the straight scoop with no hidden agenda," he says. "They crave the latter, and they know they hardly ever get it."

Mr. Johnson of the drug-industry trade group said company representatives are well-trained to answer doctors' questions about proper use of drugs and noted that they must comply with strict federal regulations on what they can say.

Modest Goals

Ms. Nocco aims to sit down four times a year for 15 minutes or longer with the doctors she has been assigned. All told, the unsales representatives are targeting about 1,000 doctors of the 26,000 across the state. For now, they are being judged by how many meetings they get with doctors. Mr. Snedden says it's too soon to detect any impact of the unsales program in Pennsylvania, but "ultimately, we need to see a change in the prescribing patterns."

Just before noon, Ms. Nocco arrived at the office of a group of geriatricians on the campus of Jeanes Hospital in the leafy Fox Chase district. In the lunchroom under a purple wall clock bearing the logo of AstraZeneca's Nexium, the heartburn pill, she unwrapped a tray of Italian hoagies delivered by a shop she discovered in South Philadelphia when she worked for Eli Lilly.

She left the drug maker in 1998 to go into advertising, specializing in prescription drugs at a small agency in Philadelphia. After leaving the agency because of family responsibilities, she worked on another academic detailing project that led to her current job in the Pennsylvania program.

Over lunch, she told three doctors about the program and joked, "I'm redeeming myself now" after years working for the drug industry.

Her subject was managing pain without Merck's Vioxx and Pfizer's Bextra, two drugs that were withdrawn from the market over safety worries. Pfizer still sells a similar drug, Celebrex, which costs about $80 for a month's supply. Ms. Nocco suggested over-the-counter alternatives such as naproxen or acetaminophen, which is best known by the brand name Tylenol. The drugs cost less than $9 a month, she said. If they don't work, she suggested prescription alternatives, including some generics. She went on to discuss a variety of options for severe pain.

After almost an hour, Martin Leicht got up to leave. "This was much more fun than a drug-rep lunch," Dr. Leicht said. "They won't come in and say, 'Use Tylenol first.' "

Recently Ms. Nocco and her colleagues have been targeting overuse of costly heartburn pills called proton-pump inhibitors. These drugs, which include Nexium, can cost more than $100 a month. Patients need to take them every day.

The unsales representatives say many people can find relief by watching what they eat or taking inexpensive over-the-counter medicines such as antacids and Zantac. If neither of those remedies works, patients can try a proton-pump inhibitor -- perhaps starting with Prilosec, a chemical cousin of Nexium that is available more cheaply over the counter. Prilosec or Nexium may only be needed for a few weeks before patients are weaned off, according to the unsales pitch.

Cynthia Callaghan, a spokeswoman for AstraZeneca, says in an email that the older drugs may be appropriate for some people but she says clinical-trial data show Nexium offers superior relief. Sales of Nexium, AstraZeneca's biggest product, increased 18% to $4.63 billion last year.

Nexium alone accounted for more than $15.2 million, or 2.8%, of total drug spending by Pennsylvania's elderly assistance program last year, or 15 times the annual budget for the unsales representatives. William Trombetta, professor of pharmaceutical marketing at St. Joseph's University in Philadelphia, says: "Given the price of Nexium, it would not take much in terms of switches to more than cover the state's detailing cost and then some."

Write to Scott Hensley at scott.hensley@wsj.com

I will freely admit that I was ticked off. Not so much professionally, after all, people are entitled to their opinions and if you don't like what I do, well you don't. That's ok. I do. That's why I do it. But as a consumer, I am really irritated. As a consumer of news, I expect a place like this to actually look into some facts before they throw something on page one. Or if it is opinion... well put it on the OPINION page. The news is pretty easy that way. But as a medical consumer? This bugs me even more. I ask my doctor to heal me. I am sick. They give advice. PRESCRIBE therapy (not REQUIRE). Maybe write a script for an agent to help. If its more than I want to pay I ask for a generic. He'll warn me if there are any problems with that. We decide. This arrangement makes sense to me. I am responsible for me. He knows what works best in his opinion (and if I don't like his opinion, there's always someone else). This article makes me feel like I am helpless to say no. I am too dumb to be responsible for taking care of myself. Grr... So here's the response. What is your opinion?

Date:	Tue, 14 Mar 2006 05:12:02 -0800 (PST)
Subject:	Poor attempt at journalism
To:	scott.hensley@wsj.com

Mr Hensley,

I am disappointed that a publication of the quality of WSJ allowed your visciously one-sided piece to run. The piece is stunningly uninformed. Just a few examples:

• "trying to help doctors make decisions grounded in scientific evidence instead of company marketing." Did you interview anyone in a drug company, either in Market or R&D or Sales? Is it possible that drug companies use 'scientific evidence' to promote their drugs? The assertion that they do not is simply gratuitius and can be rebuffed with a snort, which is all it merits.
• The FDA has to approve all the pieces used in promotion. You made no mention of this fact. I might change the perspective of readers. It might be considered fair.
• "These "detailers," so called because they can recite drug facts from memory, crowd into doctors' offices, handing out pens and notepads emblazoned with brand logos and hoping to corner the doctors for a minute or two to deliver a sales pitch." Again... stunning. You choose not to ask a physician, or a drug company about what 'detailers' are or do. You fill in an uninformed guess. Had you interviewed someone and used something other than your own opinion, you could have met a provider who realized there are merits to the use of prescription medicine. This is not a stunning revelation. And show me a company that doesn't have pens with their product on it. A car dealership. A doctor's office. They are inexpensive and are in need because patients take them from the staff. If an office didn't want pads, cups, or pens, what happens? Does someone force them to accept? Did you ask about that? Or just make assumptions. I found a lot of that.
• You provided no critical examination of the purpose of 'undetailing'. Honestly my reaction was: "Who's paying for that? Oh, a government. Figures. No one can waste money better." An informed approach to examining the value of this kind of 'unsales' force would be to identify influences that determine physician decisions in healing their patients. Someone is sick enough to seek treatment and wants a course of therapy they cannot themselves naturally provide. One assumption might be that they've tried Tylenol, or other over the counter solutions. But would it hurt to find out? Isn't that journalism? I mean no disrespect, since this is your profession, but circling an unknown and coming up with ideas to understand it, doesn't that seem like a reasonable approach?
• Some of these influences you might have learned about would be efficacy: it has to work. Though I am no fan personally of Lipitor, its studies show it is significantly better than Zocor in reducing cholesterol. There are studies that equate this to actual reductions in CV events. What does that mean? A government will be pressuring a doctor to write a drug that is less helpful in fighting my battle with heart disease? Why? Its cheaper. That's a story, if you ask me.
• Or perhaps the influence of insurance company HMO withholdings. If you are unfamiliar with this practice, I'd encourage you to look into it. That would be consistent with my understanding of journalism. The contract typically takes a percentage of monies the insurance company owes a provider and does not give it back: they withhold it. They hold it until certain conditions are met, usually related to cost savings and generic utilization. While it looks a lot like a hostage situation, it does in fact provide a reason for doctors to already be thinking about ways to use less expensive, effective medicines. An interesting quandry. Also could have been a good element or its own story.

Instead you supplied your own opinion. Your idea of 'fair balance' in representing the story included almost 2 full sentences from a drug company association. Two sentences! That is an embarassment for an instution of the quality of your to allow, and I feel I have some basis for saying this. I was raised in a home of a newspaper man. His father worked his entire career for one. I went to journalism school at every meal. "Your mother says she loves you? Go check it out", he'd say. This is not journalism. That it could exist on Page One speaks to the reality that it is not simply your opinion you are propagating, but that of others as well. I cannot believe, for all the pens at Pfizer, that an editor or two did not review this and choose it based on its 'merits'. It is just sad.

With all due respect...

Mastery

So my wife is playing with this new ipod shuffle thing that arrived at the house. She cracks me up! Says it looks just like a home pregnancy test! Damn that slays me... it does. Even has a plus and minus! How did I get it? Long, unimportant story and its free. I don't want it. She was happy to take it and play. So as she loads the software onto our computer to operate it, its asking her survey questions about her occupation. She stays home with the kids. A busy job. Lots of duties and titles. No pay... well no money... unless we sell one of the kids (note to self.... I have 3). Anyway, she was checking off job titles. Finance, Administration, Computers, Web Master. That one caught my attention. Master?

Is that a little presumptuous? Web Master? I mean it was born in a time when the pocket protector ruled the world... no one could understand what those guys were saying, but they not only weren't burned by the strange new magic, they could *gasp* USE IT! I remember this time well because I worked in finding techies for companies. The Internet was totally off the radar, except for a few guys playing D&D with their Commodore 64s. No one was around to name them, except themselves. And their decision? Master. A hearty 'screw you' to all the guys that gave them swirlies and wedgies. They are masters of their domain... compared to everyone else.

So what other jobs assert this level of bravado in their title? Zen Master, Jedi Master (kinda similar), Reiki Master (again, similar). Then some, a little less profound:

• Bass Master, Master Angler (is that fish or chix? Or Fish n' Chix... Long John Silver was a Playa. You have to know it)
• Drunken Master ( http://www.imdb.com/title/tt0080179/ ) fighting AND drinking... a pair? Who'da thunk?
• Jam Master... well there was only one. And his name was Jay. ( http://www.j-m-j.com/ ) And he liked his Addidas.

But seriously, rolling through GOOGLE, aside from master chefs, and gardeners... there's very little over mastery out there. This is what makes me wonder... what if we had to proclaim some kind of mastery in our work? Titles that might describe me?

• Sloth Master: while I've not met any, I know how to set my motor to idle, but really I am not comfortable with master. I am more of a wondering fool. More willing to be monkish, than master.

I don't know. When I was a kid I told my 3rd grade teacher I wanted to explain big ideas with little words for people so they'd be easier to deal with. I didn't know what job that was. She didn't either. But interestingly there's a word for this, and I'm really good at it. Its really the closest thing to what I do. I take big idea and reduce them to bites. I am a master of this:

bate¹ ( P ) Pronunciation Key (bt)
tr.v. bat·ed, bat·ing, bates

1. To lessen the force or intensity of; moderate:

Draw your own conclusions...

Zen & The Art Of MultiTasking

Its really quiet all of a sudden in my home. I look up and see that I am actually alone, the spring sunshine has faded to grey and the only thing I hear is the laptop fan out of phase with the hum of the refrigerator somewhere at the other end of the house. These are really rare moments in the life of a family guy. I love the family. But they come with 80 decibels of action and they're in bed, teeth scrubbed, blankets tucked, and I had no part of it. Where did this weekend go?

I see this two day period coming and start thinking about all the really 'important' things I need to do. Then a good part of the weekend I run around checking things off my list and trying not to make my wife break out in hives. She's lovely. A fabulous spirit... and to her, 'agenda' is the most heinus word in the English language. Cracks me up. I know she's right, but I am too stupid to not steam clean something or clean something or... they probably make a medicine for this. I am trying to do 3 things at the same time. Sometimes I do. I've been known to brush my teeth and hair at the same time, but when you get the brushes mixed up all hell breaks loose.

So getting to my point... I tend to digress a lot... and have a compulsive need to use these... points of ellipsis... That is not my point. This is: I've been trained in a culture of workers to do more. Productivity productivity productivity. More output with less input. I bought this notion for a long time, I am sorry to admit. It never occurred to me that the computer was a reason to slow down, not speed up. I can't compete with 128 bit processing. I am so easily distracted with 3 ideas at the same time. It wins. It can do the complicated grunt work and I'll do the... what is it that I'll do? Something a computer can't do.

I'll listen. Funny thing about that whole listening bit. It takes time and attention. You get a lot of information out of it and a computer can't really sort out what's important. Just people... or the ones who are listening at least. And it occurs to me that its a momentous thing... to take a moment and listen. Pay attention. Not type and listen. Not flip channels and listen. Not read and listen. Just listen. To do two things is to not fully appreciate either. Waste one moment in two half-quality attempts. But I've been doing that. I've done that. I do this. I did that.

I've been raised to try to do 2 things at the same time because its better. More stuff got done. If you could do twice that, it would be 4 times better. Like a machine. But I am more than the sum total of my honey do lists. My value is not in doing? So maybe I do dishes and listen to the radio, but I think I've wandered way off the trail somewhere. The zen moment... understanding the infinite detail of this one moment, and then this one... it is a delicate thing. Easily crushed by carpet cleaning, conversation holding, furniture dusting, blog thinking people. Sometimes I wonder if I keep moronically busy like this to avoid silence. But this feels so soothing... except for the refrigerator fan, which makes me wonder why its running all the time and if the seal needs to be replaced on the door and.... sometimes silences bring up awkward introspection. Hard to see that I could be more by doing less and that by doing more I am lessened. And am now more; seeing I am less.