Thursday: Better Than Fine

I wake up with a scratchy throat and that downward feeling that comes with realizing that it’s Thursday and I don’t have a lesson plan for the class I teach at 1. Downstairs, the cat has thrown up in three places, all of them carpeted. My Partner is not sure that it’s vomit, he thinks it looks more like poop. I dab a spot with some paper towel and bring it to my nose. Not poop. In fact in smells surprisingly springlike — earthy and green. This is because Cuddles has been eating the greens from the Spring Fling bouquet I sprang for at Family Fare yesterday when I was waiting for my prescriptions to get filled because I’d already been two days without my Prozac and was getting grumpy and droopy and experiencing bouts of extreme self-loathing.

MP makes us some breakfast while I empty the dishwasher. These dishes are not clean. They have been washed, but they are not clean. The plates and bowls are dingy and dull and the cups are coffee stained. How long has this been going on? Could be months — it’s been that long since I unloaded the dishwasher while the sun was shining.

Before I sit down to my poached egg, I also take in the kitten-sized balls of golden retriever fur in the corners of the dining room, the wall behind MP’s chair where the paint is badly chipped, and another puke spot under the table. I take a sip of coffee, closing my eyes so I won’t see the brown stains on the inside rim.

Should not have let that prescription slip.

When I arrive at the small seminar room on the second floor of Van Zoren Hall, my class of Academically Talented middle school students is already seated in the tiers of desks that I usually haul down from their platforms and rearrange into a circle. I decide to let it go. We have just finished reading “Much Ado About Nothing” and Sarah has a question: Why does Boracchio say “listen to me call her ‘Hero,’ hear her term me ‘Claudio,’” when he intends to have Claudio there as a witness to Hero’s debauchery?

Really? He says that? Indeed he does. Sarah has highlighted the passage in passionate pink. It makes no sense to any of us. Did Shakespeare screw up?

Three hours later I drag myself in through the back door and notice a definite smell of cat pee. Eliot’s breakfast dishes are hardening on the counter but where is he? Monday’s piano, Tuesday’s Jazz Combo, Wednesday’s trombone, Thursday’s here. MP hasn’t seen him. I dig my phone out of my purse. No messages. I send Eliot a text: “?” and fall into bed. Ten minutes later my cell wakes me with the “Waltz for Debby” ringtone I downloaded in another lifetime, before my dad died. Eliot is on his way home from band festival, which he told me about last week, remember?

I do not remember.

Sitting on the — jeez, where did those spots come from — couch, I hear MP shaking up a Maker’s Mark manhattan. My favorite sound in the world. The drink he pours me glows red-gold and the first cold sip is the best I’ve felt all day.

By the time I’ve finished my second drink, Eliot is home and regaling us with tales of Peter the sax player who thinks he’s all that but started playing the wrong song at festival. The living room glows like a manhattan, full of going-down sun. I love my son, My Partner, my shedding dog, my puking cats, my hairy cornered home. MP looks askance when I ask him for another drink to sip on while I make supper. I am meeting my Academically Talented students and several of their parents at the dress rehearsal of “Much Ado About Nothing” at 8:00.

I’ll be fine, I say. I’m making Kitchen Sink Quesadillas and I’ll have coffee after dinner.

Kitchen Sink Quesadillas

1 package burrito-sized flour tortillas

1 package shredded cheddar

1 can black beans

1 can corn

1/2 jar Paul Newman’s Spicy Salsa

Heat oven to 400. Line 2 cookie sheets with parchment paper and place two tortillas on each.

In a colander, in the sink, combine beans, corn, and salsa.

Sprinkle tortillas with half the cheese. Add a layer of the drained colander mixture and another layer of cheese. Top with the remaining tortillas.

Bake 5 – 10 minutes, until cheese is melted and tortillas are crisped. Serve with sour cream, avocado slices, and hot sauce.

You’ll be fine.

Everyone had seen the infamous pictures of the “Faces of Meth” – before and after shots of daily users of crystal methamphetamine.

Yet there are no pictures of the “Faces of Effexor”, “Faces of Amitryptaline”, etc, etc…

***Grossness Factor Warning***

I never experienced problems with acne as a preteen or adolescent, but ever since I’ve been on psychiatric meds very strange things manifest themselves on my skin (for the most part not on my face, for that I am lucky, as I have seen what these drugs have done to others’ faces, and of course the first thing someone looks at when they see you is your face).  Two other women I’ve known broke out into horrible acne after beginning to take various antidepressants – SSRIs and Tricyclics.  Both ended up taking the drug “Acutane” to try to get rid of the welts on their faces, a very dangerous drug in its own right – it dries out not only the skin, but other bodily tissues, and can cause permanent bone damage and early onset Osteoporosis, especially in women.  Their faces cleared up, although not entirely.  The effects of Acutane on their future health remains to be seen.  It is very interesting that both did not even consider dropping the psych meds instead of “adding on” the dematological med.

The things that come out of my skin are restricted to one massive pustule on the right side of my neck, and various “things” that show up on my back, that range in colour from black to white.  The pustule on my neck is most disturbing.  It is sometimes flush with the rest of my skin, but then always begins to swell periodically.  Then, it inevitably bursts, and out comes green, yellow, and white pus, followed by orange and then blood.  Recently, smaller white bumps, that also spit out white stuff – very hard in texture – have gathered around the main pustule, which has permanently scared my skin.

Reading over the “side-effects” for Effexor XR, acne on the neck is listed.  Yet I would not call this acne – it seems rather to be a deposit of garbage that is disconcertingly close to the lymph glands in my neck.

I would like to see a poster of the “Faces of Psych Meds”.  I think I will make one if I can gather enough pictures, before and after.  I think such a poster would be a great display for high-school gymnasium walls, where the meth one usually can be seen.  Since psych meds are more addictive than methamphetamine (according to the World Health Organization) it is unethical that adolescents are taught about the addictive powers of meth, cocaine, heroin, and the like, but not psychiatric medications.  Since all teenagers worry about their appearance, the “Faces of Meth” campaign has been very successful in reducing meth use among teens.  I wonder what effect it might have on their (future) decisions to try an antidepressant…

Just an idea that popped into my head as Alaryyk popped one of the mini-pustules that feeds off the main one on my neck.

I wanted to post about the pharmaceutical company-produced “documentaries” that are shown in psych wards and social workers’ offices today, but alas, my paid work calls.  So that will be all for today

I promise a longer, less disgusting post for tomorrow morning

If you’re starting (or have been doing so for a long time) to question the pharmaceutical industry, are interested about the rebranding of drugs for profit, the creation of new disorders to sell new pills, or the effects of SSRI antidepressants on children, I highly suggest you watch this documentary.  Dr. David Healy, a psychiatrist and author (one of my favourites), who is critical of the psychopharmaceutical industry is interviewed at length.

Here is the full-length documentary, broken into five parts:

Am fost atat de prins cu sesiunea si cu facultatea in general incat nu am mai avut timp nici macar sa pornesc Xbox-ul in ultimele doua luni. Am vrut sa scriu pe blog despre o tona de chestii si multe idei din pacate s-au pierdut pe drum. Abia daca mi-am mai actualizat twitter-ul. Stateam acum cateva zile si ma gandeam serios ca din toamna as vrea sa plec in Marea Britanie pentru a-mi continua studiile acolo (ma refer la facultatea de psihologie). Altceva nu am in program momentan. Incerc sa tin pasul cu ce se intampla in jurul meu, cateodata mult prea repede. Pana trec peste astenia de primavara (a spus cineva Prozac?), va recomand doua blog-uri dragute/interesante http://willmark.voce.ro/ si http://www.worsakeend.tk/ pe care am sa le trec in curand si in blogroll cu permisiunea autorilor.

RazvanG

I am so sick of hearing this ad come on around dinner time everyday.  I guess the idea is to hit people with it, women especially, when they are getting home from work.  Indeed, “I have just worked an 8 hour day and I still have to make dinner and pay bills and…”

…and then this ad comes on and saves the day.  Let’s watch it, and then discuss further…

First of all, who doesn’t have to “wind themselves up” just to get out of bed?  Our bodies are not programmed to wake up at 5:30 am, in the dark, to make the long commute to work or go to the gym (something you’ll want to start doing, if you’re not already, after you start taking this pill).  With all of the demands put on us in the hyper-modern world – more and more bureaucracy that we are expected to navigate and work into our schedules, more and more competition to keep a firm hold on your job, more and more stimuli in the forms of advertising and flashing lights to digest – I don’t know very many people that get the amount of sleep they wish they could, or the amount doctors recommend getting.  I don’t know many people that hear their alarm in the morning and rip off the blankets and jump out of bed with a huge smile on their face.  Yes, life is wearing us out, but for good reason.  Our bills are getting higher, but our pay damn well isn’t.  But we’re expected to work unpaid overtime.  This ad is sandwiched between footage of the most recent war being waged abroad, or images of today’s stock market “progress” – two huge red arrows pointing downwards, or a picture of a missing child.  Daylight hours will be extended this weekend, but with more sun will come more smog – take a deep breath of fresh morning smog – ahhhh, if that doesn’t wind you up, you must require a doctor’s assistance!

This little character that “just keeps going and going and going and going” used to be called the Energizer Bunny, a battery-powered device.  We humans are not battery-powered devices!  Yet these pills and diagnoses (“depression” at first…then maybe something more if that antidepressant doesn’t act as a battery-pack within 4 weeks) tell us that if we aren’t behaving like the energizer bunny there is something wrong, that we are “abnormal”, we are sick, and like a diabetic needing insulin, we need our desvenlafaxine.  (An Effexor isomer, of course, as the pharmaceutical industry has not come up with anything “better” for a very long time.)

If the world is getting you down, if you feel like you constantly have to “wind yourself up” just to keep going within it, it may not be you, but the world that is the problem.  Of my own late-twenties to early-fourties group of friends, I don’t know of a single person who is feeling content right now, or whose robotic forward motion and painted on, never-fading smile matches this wind-up doll’s.  Let’s take the example of two women.  One is on an antidepressant.  Two, actually.  She was laid off two jobs in one week (the second before she even started it, because of “corporate restructuring”) and sleeps late into the afternoon, pretending the world doesn’t exist for as long as possible.  Another woman is not on antidepressants, and is secure in her employment.  She attends toastmasters and runs half-marathons frequently, but is not “happy”.  The poor thing didn’t realize that she could not withdraw money from her RRSPs without being penalized by high taxes.  She has taken out a $25,000 line of credit for her formerly very wealthy father, who is now facing bankruptcy.  Now, she plans on working until she has amassed $10 – $15K in her savings account and then taking off.  Where?  She does not know, as long as it is far away and very different culturally.

Then there’s me.  I’m on the original Effexor, venlafaxine, as well as Lamictal (lamotrigine), which is supposed to prevent depression in “bipolar people” even further.  If I didn’t take my Klonopin (clonazepam) every few hours, I would feel very wound up!  But not in the way this doll in the commercial does.  I would start thinking so fast that the tension headache would come quickly as would the frown or perhaps even tears, as I went in my head through lists of things that need to get done, but I wouldn’t know where to start – what is more important, waiting on hold for 60 minutes with B.C. Health Insurance to try once again to get the medical coverage I should have qualified for last August, trying to come up with a creative idea as to how I will pay my tuition, or working on one of the three final papers, 6000 words in length each, that are due in a month and will determine whether or not I will be able to continue in my chosen career path?  Yes, wound up but paralyzed, and probably staring at the television, watching this commercial.

Commercials like these make the suggestion that as many as one out of two people suffer from “depression” and need to be on a medication like Pristiq.  Yet, we are not allowed to speak with one another about how depressed we are.  I don’t know of any office or graduate program where the topic of “depression” is scheduled to occupy part of the morning meeting, and there is still so much stigma around feeling down that we are scared out of our minds to talk to other people about it.  Maybe Suzie in the cubicle on my right is also finding she constantly needs to wind herself up just to finish some of this monotonous work, but shhhhhhhhh! – it’s a secret.  ”How are you today?”, “Good, how are you?”, “Oh, I’m good!”

No, we cannot talk to each other, but we can “talk to our doctors” about this!  Finally, someone to talk to.  Someone with about five minutes to spare and a prescription pad in their hand.

And on this note I would like us all to consider that Pristiq may not be the answer.

I’m sure if you browse throughout the Effexor forums on “weight” you will notice people claiming they are rapidly losing or gaining weight. I have browsed through countless forums through countless hours looking for some hope or some type of original experience. In the end I have realized all of the stories end up the same.  – Those who are lucky to lose 10, 20, even 30 lbs in the first 6 months of taking effexor eventually gain it back.  And then they gain more and more weight until they are left like me 80 lbs heavier than they were before they ever took this drug.  I have been unable to find a story where someone has been on this drug more than a year and kept losing weight.  Inevitably as in any honeymoon, the phase will end and turn into an abusive relationship between you and a drug which lowers your metabolism, changes the chemistry of your fat, destroys your thyroid, retains your water and adds it to fat composites,  tricks your brain into thinking it’s not full by blocking the histamine receptor, and tells your body to crave mountains of sweets.  This information I have attained from reading various scholastic sources.

And if you haven’t heard the myth that doctors told you yet about diet and exercise, I’m here to give you the gruesome fact.  Drinking extra water, normal diet and exercise does NOT neutralize the weight gaining effects of effexor.  Anything else contradictory to this is a blatant lie.  If you were eating healthy and maintaining your weight before taking this medication, get ready for a diet and exercise regimen of your life in order to MAINTAIN YOUR WEIGHT.  Because I can tell you the second you stop dieting and exercising EXCESSIVELY, your weight will pile on like you wouldn’t believe.

For 7 of the 9 years I have been on effexor I actually fought for my weight and maintained it.  I worked out 6 days a week doing an hour of running and 40 minutes of weight lifting as well as keeping a strict diet to prevent myself from getting fat.  The second I went to graduate school I had to limit my exercising to 2-3 times a week and had to go back to a normal diet due to time restrictions. (Although a normal diet for me is still a diet.  It is high in fruits and vegetables and limited to lean protein and low on junk food and bad carbs.  The diet I need to be on while trying to keep my weight off is more extreme.)  In that year of graduate school I gained 50 lbs.  That’s right- 50 POUNDS with diet and some exercise.  This is the same type of diet and exercise a ‘normal’ person ‘not’ on antidepressants could lose weight on.  After a year and a half of graduate school I gave up.  I rarely exercised and just kept on my diet.  When I cut out most exercise I gained 30 POUNDS IN THREE MONTHS!  So after a study of just my experience I find that:

A) extreme diet and exercise (14-20 hours of exercise a week and eating nothing) will maintain my weight.                                                                                                                                                                                                   B) moderate exercise and a diet (6 hours of exercise a week and eating a weight watchers diet) will make you gain weight (for me the rate of gain 4.2 lbs a month)                                                                                                                         C) rare exercise and a diet (1 hour of exercise a week and eating a weight watchers diet) will make you gain a TON OF WEIGHT  (for me 10 lbs a month)

This is just my story.  There are thousands of stories identical to this on internet threads and forums.  I have read about anorexics, Olympians, dietitians, and weight trainers run into the SAME conundrum. They too have fallen into the same black pit as I have.  They put on weight when they take effexor even though there is no change in their exercise or diet.  In a way it made me feel more sane reading their stories. I truly felt like I was losing my mind not being able to lose weight when I worked harder than I have ever worked in my life.  However in the end I was depressed after reading their stories because a great deal of them turned out bad.  Most people were unable to take the weight off that they gained from the Effexor after they discontinued the drug.  It seems that it does long term damage to your system.  However I am hoping I will be one of the lucky few who either immediately lose weight after discontinuing or lose some weight after the effexor is completely out of my system (which will take up to a year).   It’s different for y so all I can do is wait.

To fill in the gap on the 6 months between gaining 50 pounds and then another 30 pounds after giving up I will describe every diet I used to try to lose the 50 pounds I gained.  The end result was maintaining my weight and losing nothing.  That is when I gave up and gained another 30 lbs.

Alternating 1-2 hours of Zumba (a super intense workout that burns 1000 calories each session) and Dance Dance Revolution on Hard core level a day for 5-7 days a week, as well as hour of walking every day, 40 minutes of weight lifting, sticking to weight watchers without deviating,  taking benefiber, Metamucil, or  fiber one for increased fiber intake, substituting nuts and beans for lean protein, replacing junk food with dark chocolate and flax seed omega 3 cookies for dessert in moderate proportions, cutting out processed foods and complex carbs, eating good carbs such as wheat, sweet potatoes, brown rice, oatmeal, going organic to eliminate toxins, increasing antioxidants by eating acai juice, eating ’superfoods’ such as papaya, flax seeds, and salmon, cooking with extra virgin olive oil, drinking a gallon of green tea every day, adding ginger, lemon, mint to water, apple cider vinegar in my water, drinking 12-16 glasses of water a day, cutting out dairy (dairy is bad because of all of the hormones that make you gain weight) and changing from soy to almond milk, taking probiotic, experimenting with caloric intake from 1400-2800 calories a day, cut out foods with high fructose corn syrup and aspartame, eating 6 small meals a day to speed my metabolism, cutting ALL Alcohol, trying slimfast, the red wine diet, taking vitamin C, etc. I’m sure there’s a lot I missed believe it or not.

After all that was said and done, my doctor said I was either eating too much or too little.  If I said I eat hardly nothing and exercise 2-3 hours a day, then she said I wasn’t eating enough to lose weight.  If I said I didn’t eat junk and ate the right amount, then I was eating too much.  It was always something ‘I did’ and not the effexor.  This was extremely frustrating as she wasn’t going to help me after not taking me seriously.  So after 9 years of not taking me seriously I have gone from a size 14 to a 20. (mind you a size 14 is perfect for me since I am 6 ft tall and have a large bone structure particularly in my rib cage. It is physically impossible for me to get smaller than a 14 unless I break my ribs! lol!)

I am so certain that there is nothing that can be done to lose weight while on this drug that I can bet I would fail miserably at the Biggest Loser.  What surprises me is that there’s no  public awareness of this problem. You never see articles in magazines, tv shows such as Dr. Oz or Dr. Phil that deal with this issue.  Instead they ALL say there is no excuse for not being able to lose weight. In fact I wouldn’t be surprised if some immature person (like my mother in law) commented on this article saying something to this effect “all you have to do is get off your fat ass” or “I don’t believe you.  All you have to do is diet and exercise.”  I have seen idiotic remarks like this all over the net.  Well unless you have taken this drug for more than a year,  you have no say or credibility to contradict my argument.  I would love to hear a successful story of someone who managed to keep their weight from ballooning out of control after being on this for as long as I have without taking extreme measures.

Currently I am still in a state of limbo.  I decided not to let the fear of gaining weight not rule my life.  I am not going to sit around all day and do nothing.  At the same time I am not going to go crazy and exercise 20 hours a week.  I’m sure that walking an hour a day while on a diet will just keep me around gaining 5 pounds a month.  When I am off this drug I have other plans to get my system going.  This site has truly inspired me to try a different approach.  http://www.theroadback.org/weight_loss.htm  Mind you I have no affiliations with this program.  This is just something different I am going to try and will tell you if there are results.  Long story short it involves taking Omega 3 fish oil, CLA, calcium, and vitamin E everyday to reduce inflammation and lose weight. Besides this I am going to try a hypothyroidism exercise plan.  (I might as well have hypothyroidism with the troubles I have.) The link to that plan I posted at the bottom. It involves 40 minutes of interval exercise 3-4 times a week.  Unfortunately I will not be able to have an immediate answer or a result. First I wont really find out if it works until I stop taking the effexor.  Even then I might not see results for a year depending on if my damage is non-reversable.

http://thyroid.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=thyroid&cdn=health&tm=414&f=21&su=p284.9.336.ip_p726.5.336.ip_&tt=2&bt=0&bts=0&zu=http%3A//www.thyroid-info.com/articles/exercise.htm

Since returning from London where I have been taking a semester of courses, I can now begin to work with some doctors on getting off this evil drug.  I have finally found a psychiatrist to work with who will not push pills on me or try to switch me to another drug.  Unfortunately I have been unable to make an appointment with him because he doesn’t push pills on his patients.  In other words he is high on demand and overbooked because hs is so good.

Well I finally took some initiative after waiting and waiting 4 months to get an appointment. I am still waiting for an appointment.  So instead I went to my family doctor and told her to give me smaller doses so I can begin tapering.  From literature that I have read it is the smaller doses that need the most care and doctor’s attention so I figured I can deal with getting down to 75 mg without a psychiatrist.  When I get to that point, I am certain I will need Prozac to extend the half-life so the side effects are not as gruesome.

Currently I have been tapering at 75 mg doses.  From 225 mg to 150 mg in two weeks.  I know this is too fast but I would rather suffer the side effects in a short period rather than tapering over the course of 9 months.  9 Months is would be the rule of thumb for me in particular that a doctor (who knows what they are talking about) would advise.  You are generally supposed to ween one month for each year you have been on it.  Since I have been on it for 9 years, then it should take me 9 months to get off this stuff. I want to get off it in two months.  I decided this is the best course because I don’t have a job and am finishing a graduate school project (thesis) and can afford to feel like crap for 2 months.  After May I think it would be more difficult to taper off this stuff since I would be losing health insurance and will have no idea where I will be living as I need to get out of my parent’s house and find a job.

To get to the point I am doing considerably better than I thought I would be doing after cutting my dose in half.  Week one I went down to 225 mg and felt absolutely no side effects.  That was far easier than taking the pill apart and counting beads.  That strategy I do not plan on implementing again until I lower my dose from 75 or (more likely) 37.5mg.  However depending on whether my psychiatrist prescribes Prozac at that time, I may not need to count beads.

Week two was much more difficult.  I could really feel the side effects.  They included the brain zaps and shivers, nausea, EXTREME fatigue (sleeping 14 hours a day and still tired) heart palpitations, loss of vertigo, the feeling that an alien is about to burst out of my chest like in the X-files movie, increased orthostatic hypotension (fainting and headaches after standing up), and feeling like crap.  The first few days were bad but manageable.  They were not as bad as it was when you miss a dose, however they were 70% as bad.  Being home makes this much easier. I cannot imagine trying to do any type of work while getting off this stuff.

The last two days I have taken 1000mg of Omega 3 fish oil . (This is recommended on http://www.theroadback.org/aaataper.htm).  This has improved the neurological side effects.  I am currently starting week 3.  This week I will continue on 150mg until I feel little to no side effects for a week.  This will mean my brain/body should be somewhat accustomed to this dose. Then I will taper down to 75mg.  I am expecting that to be much more difficult and painful.  I am certain my persistance will keep me motivated to stay on track.

On a side note I would like to note the literature I have read about effexor wearing off over time.  At some time I came across this information and completely agree with it at this point.  From my experience of being on this drug for 9 years I have been through several periods of depression and suicidal points (even recently).  I have also noted that my obsessive compulsive symptoms and thought processes are the same as before I went on this medicine.  This is something that slowly happened throughout the years.  I especially feel the effexor is no longer effective because I am feeling no difference in my mood since lowering my dose.  I cannot stress this enough.  I am not experiencing the normal depression that comes with tapering off this drug.  It only makes sense that this drug does not work anymore.  My hypothesis is that people who have been on effexor for a short period of time are more likely to feel suicidal and extremely depressed during the tapering process because the drug is still effective for them.

As I walked into the office, the main thing I noticed was the overwhelming number of magazine stands around the room. I mean, I understand wanting to have reading material around for patients to read while they wait to see the doctor, but there were literally magazine stands on each side of every chair in the office. I went up to reception, signed in to see Dr. Mefis, and grabbed a chair in the corner. Bored, I looked over at the stack to my left. All trade magazines for doctor’s offices, titles like WebDoc.com and Psychology Tomorrow, with giant smiles and unseen sticks up models’ butts. Not in the mood to be sold shit, I perused the rack to my right. Identical, down to the placement of the magazines in each row. I double checked – yep, the same exact corner was folded over on the corresponding gemini Pharmacology Monthly framing each side of my seat. Odd.

The sound of something heavy slamming on a desk grabbed my attention. A loud thud, followed by something similar to a ringing bell.

NEXT! My turn at intake.

Approaching the desk, I notice the source of the thud – an old school 1940s cash register being lifted to the counter and roughly thumped around by two scrawny and petite nurses. THUD. RING.

After being handed a few forms, I pick up a typical fat Pharmaceutical pen from the counter and a similar clipboard. The pen says “Scrotozome – Because everyone deserves normal-smelling genitals.” The clipboard just says “Liftor – From the Makers of Zoloft and Viagra.” I’d normally laugh, but I’m about to enter the ranks of the judged. The dependent. The medicated.

****

A week earlier and I’m golfing with my family for Father’s Day. I ride with my brother John, each of us providing commentary on the nature of the day. What surprised both of us by the 9^th hole was our other brother, Ian. He wasn’t doing exceptionally well this round. In fact, he’d already lost 4 balls to a stream and one bounced off a tree, whiffed –past his head and smacked into the cart before bouncing up to the ladies tee. Andy and I almost laughed, but bit our tongues. Christopher has a bit of a temper on the golf course.

But not today. He was having fun. He was reasonable. He took second and third tee shots and ACTUALLY COUNTED THEM. By the time the 18^th hole came around, he was downright pleasant to be with.

“What the hell’s with Ian?” I asked John.

“He didn’t tell you? Paxil. Amazing what modern science etc etc, eh?”

Amazing. And consequence free, bear in mind. No strings attached.

****

“Mr. ——-?”

For the record, that’s me. “That’s me.”

“This way,” says the nurse.

I can’t help but snicker at the two slight nurses still desperately trying to arrange the old fangled cash register at the out-take window. “What’s with the cash register?”

“Well, Dr. Mefis wants to create a feel in here, like a real classy 1940s feel. Patients wearing hats and dresses, better manners, no gum chewing – a real character to the place. Something to set us apart.”

“Really?” I mean … it’s a doctor’s office. A place to come when you’re sick. A place to get well.

“I dunno. You’re the one writing this elaborate setup…”

She leads me to the Doctor’s office. True to form, the door has a frosted window. Painted in gold letters, his name – Dr. Damien Mefis, MD.

“——-! Good to see you again!” No smoke, no mirrors, no smell of sulphur. Just a doctor, in a chair. “What brings you to need my services this time?”

I explain my situation – going through law school, tough finals, waiting to hear back about submissions to journals, no job for the summer, just got engaged, just put in a bid on a house. The usual. Stress. “And I was wondering if you thought maybe I might experience any benefits from trying out some…”

“Some Paxiiiiil, maybe?” He literally draws out the word. It sounds enticing. Seductive. He lures me in with his mouth.

“Yeah,” I say. “My brother has tried it out, and it’s really been doing wonders for him.”

“Well of course it has! It’s truly a miracle, in this modern age. A real godsend for those of us overwhelmed by the weight of life. You know something, ——? This I going to be good, I can tell!”

“Well, you’re the doctor!”

“I am, aren’t I? HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!” He laughs for an uncomfortable amount of time. I try laughing with him for a few moments, but a hyperactive seizure shakes his body so violently I begin to worry. At any rate, I’m certainly not sure what’s so funny.

“KACHING!” he yells, and claps his hands.

“I’m sorry?” I ask, but just then an Asian nurse enters the room.

“Kaching, please get Mr. ——‘s paperwork together. He’s going to need a prescription for-“

“For PAXIL?!”

“Why yes, Dear. For Paxil.” He hands Kaching the paperwork and she exits the office. I get up to leave.

“Oh, and Mr. —–? Damien Mefis? Really? Like Mephistopheles? You don’t think very much of your readers, do you?”

“Not even a little, Doc. Wait for the cash register payoff.”

“Well, Mr. ——. Enjoy your prescription. And here, try some free samples! This one turns your tongue’s salt receptors off! Or how about this one? It supposedly turns your feces purple!”

I leave with pockets full of individually wrapped candies. Its like Pharmoween. Signing my paperwork, I hand over my credit card. “Oh, sorry,” says the nurse, “We only take cash now.”

I hand over my bills and the nurse hands me a prescription for Paxil. Its written on a prescription pad with a Paxil logo across the top. As I leave the office, the nurse finishing counting out my bills and presses a single button on the register.

KACHING!

*****

It’s the final day of my internship. It’s my first day on Paxil. I have had to leave the courtroom 3 times to run to the bathroom with the spits. I feel dizzy, nauseous, and about 5 steps behind myself in time. I feel numb, both physically and mentally. I feel nothing.

About a month ago I’d informed my boss that I was interested in working here full time at the end of school. This is, and remains, my dream job. A prestigious stepping-stone in a career. A leg-up in a competitive field. A real chance to learn and to make a name for myself. It was a long-shot, but I’d made my case over the course of the semester.

End of the day. I’ve puked three times, and I am leaving a bit early. They probably think I’m hungover. Right as I am leaving, my boss approaches my desk. She’s wearing the biggest smile I can remember seeing in years. From anyone.

“I just wanted to let you know, we’d love to have you come back when you finish school!”

I got it. I nailed it. My dream job, and the start of a fantastic career.

“Wow,” I say with as much enthusiasm as I can muster. It’s barely a drop in a desert of apathy and dizziness. “Hooray.” Without another word I slink off to find my car in the parking garage. I have no idea where I parked, and I won’t be getting home anytime soon.