This is a game changer.  If they ban the hydrocodone/APAP combinations, that will be the end of Schedule III hydrocodone.  JP thinks this would be a good thing.  If MDs want to run “Prescription Mills” I want their DEA recorded with each Rx.   Here is the whole magilla if you want to read it.

FDA urged to ban popular painkillers

A federal advisory panel voted narrowly Tuesday to recommend sweeping safety restrictions on widely used painkillers, including reducing the maximum dose of Tylenol and eliminating prescription drugs such as Vicodin and Percocet, because of their effects on the liver.

ADELPHI, Md. — A federal advisory panel voted narrowly Tuesday to recommend sweeping safety restrictions on widely used painkillers, including reducing the maximum dose of Tylenol and eliminating prescription drugs such as Vicodin and Percocet, because of their effects on the liver.

The two drugs combine a narcotic with acetaminophen, the ingredient found in popular over-the-counter products like Tylenol and Excedrin. High doses of acetaminophen are a leading cause of liver damage.

Acetaminophen is combined with different narcotics in at least seven other prescription drugs, and all of these combination pills will be banned if the Food and Drug Administration (FDA) heeds the advice of its experts.

Vicodin and its generic equivalents alone are prescribed more than 100 million times a year in the United States.

Acetaminophen is included in a vast array of over-the-counter cough and cold products, including Nyquil, Excedrin and many others. A small share of accidental poisonings result when people take two or more of these combination products without understanding the peril.

Laureen Cassidy, a spokeswoman for Abbott Laboratories, which makes Vicodin, said, “The FDA will make a final determination, and Abbott will follow the agency’s guidance.”

The agency is not required to follow the recommendations of its advisory panels, but it usually does.

The panel’s 20-17 vote to recommend a ban on the combination prescription drugs was one of 11 it took at a meeting called to advise the FDA on problems arising from the extraordinary popularity of acetaminophen. In 2005, U.S. consumers bought 28 billion doses of products containing the ingredient.

While the medicine is effective in treating headaches and reducing fevers, even recommended doses can cause liver damage in some people. And more than 400 people die and 42,000 are hospitalized every year in the United States from overdoses.

In hopes of reducing some of these accidents, the committee voted 24-13 to recommend that the FDA reduce the highest allowed dose of acetaminophen in over-the-counter pills like Tylenol to 325 milligrams, from 500. And members voted 21-16 to reduce the maximum daily dosage to less than 4,000 milligrams.

But they voted 20-17 against limiting the number of pills allowed in each bottle, with members saying such a limit probably would have little effect and could hurt rural and poor patients. Bottles of 1,000 pills are often sold at discount chains.

“We have no data to show that people who overdose shop at Costco,” said Dr. Edward Covington, a panel member from the Cleveland Clinic Foundation.

Some doctors already avoid prescribing pills that combine acetaminophen with narcotics like oxycodone (found in Percocet) and hydrocodone (in Vicodin).

“It ties the doctor’s hands when you put the two drugs together,” said Dr. Scott Fishman, a professor of anesthesiology at the University of California, Davis, and a former president of the American Academy of Pain Medicine. “There’s no reason you can’t get the same effect by using them separately.”

He said the combinations were prescribed so often for the sake of convenience but added, “When you’re using controlled substances, you want to err on the side of safety rather than convenience.”

Still, some doctors predicted the recommendation would put extra burdens on physicians and patients.

“More people will be suffering from pain,” said Dr. Sean Mackey, chief of pain management at Stanford University Medical School. “More people will be seeing their doctors more frequently and running up health-care costs.”

In a statement, Johnson & Johnson, Tylenol’s maker, said it “strongly disagrees” with the proposed restrictions on acetaminophen, adding that they would be likely to “lead to more serious adverse events as consumers shift to other over-the-counter products,” such as ibuprofen and aspirin.

Linda Suydam, president of the Consumer Healthcare Products Association, said the committee ignored studies showing that doses sold by her members — two pills of 500 milligrams, up to four times a day — were safe.

“I think this is a very effective dose and one needed for individuals who experience chronic pain,” she said.

The committee also turned its attention to over-the-counter children’s medicines containing acetaminophen, voting 36-1 to limit them to a single formulation. Right now the liquids are sold in two different concentrations, leading to confusion among doctors and parents.

The FDA asked the committee whether it should ban combination products that include acetaminophen. The vote was 24-13 against such a ban, with many members saying consumers saw the products as valuable.

“Based on the data provided, the combination OTC [over-the-counter] medications really contributed very little to overall poisonings,” said Dr. Osemwota Omoigui, a panel member from the Los Angeles Pain Clinic.

The panel voted 36-1 to recommend that the prescribing information for such products include a boxed warning, the agency’s most urgent caution, about liver dangers.

I was up to my ass in alligators when a heavy set twenty-something woman asked for my help.  She was pleasant and waited her turn.  I was happy to help her, if I could.

I had a hard time not laughing because she sort of hopped as she walked.  Her problem was a broken toe, the long one right beside the great toe.  It was bruised purple.

“Are you sure it is broken?”  I asked.  She was in beach clothes and was wearing flip flops.

“I just came from the doctor’s.  They took X-rays.”

“What advice did the doctor give you?” 

“He said to stay off it, but I’m not ruining my vacation.”

“You’d be better off in shoes.” 

“But this is her vacation,” a woman who identified herself as the mother complained.

I spoke to the young woman.  “I think you should stabilize it by taping it to the big toe and the third toe.” 

I actually had experience with this.  One Friday night in 1970, I was having an argument with my first wife.  I came home after work to find her drunk….. Again.  We were in the back yard.  I was sitting on the picnic table.  She took a drunk’s aim with her foot and missed.  She was going for my privates, but kicked the bottom of the table.  The doctor at Kaiser Permanente suggested taping the three toes together for stabilization.

“I never heard of that,” the mother piped up.  She was a forty-something beach beauty.  Well tanned.  Buxom, with a few pounds too many on her ass and waist-line.  It doesn’t take much to take bikini out of the picture.

“If you are going in the gulf you probably better use the best tape.”

“Tape toes together?”  The mother.  “That doesn’t sound right.  Don’t you have a toe splint.”

I turned to her.  “Do you want to help her, Maam?”

“Just leave us alone, Mom.”

“But a splint would………….”

I started for the pharmacy.  I pointed at the mother and said, “I have work to do so you are on stage now, Maam.”

“Mom, he’s the pharmacist.”

“I just want to help, Precious.”

“You aren’t helping.  Go.  Get away”

I didn’t miss a beat.  I kept walking to the pharmacy until I heard a hopping sound from behind me.

Please, Mister Pharmacist.  She’s gone.   My Mom’s gone now.”

It is bad enough that we do not get paid for this.  I walk from this type of situation, but the one where I walk the most frequently is when a “customer” argues.

“Well, why is this the best?  Why isn’t that the best?”

I am outta there.  “Sir, I gave you my best advice.  Take it or leave it.”  I am gone and they will have to wait until I am really not busy before I will give them a second chance.

A Bad Hair Crazy Day

Crazy does not mean anti-social.  Crazy does not necessarily mean unkempt, unsanitary, offensive or mean-spirited.  Crazy is not silly, laughable or entertainment.  Crazy is definitely not stupid. 

Ever since Ronald Reagan said, “We will no longer warehouse our mentally ill”, the pharmacy is the place where they get the gear needed to navigate in the world.  We call it Clozaril, Seroquel, Abilify and Zyprexa… among others. The problem is that “chemical warehousing” with the best agents is ridiculously expensive.  No insurance and the crazy person is hung out to dry. 

Think homeless. 

I was called out front and this older woman introduced herself to me with these words, “I am just your neighborhood insane person.”  She looked for a reaction and got nothing from me. 

I nodded, “We’re all a little bit crazy.”

“I am talking insane,” she added.  “There is no little bit about it.”

There is very little short of child abuse that can get a rise out of me. I didn’t

take the bait.

She gave me a winning smile and I thought, she’s flirting with me.

“All right, you feel crazy today.”

She frowned and went on, “I hope that you will be patient with me.  I try really hard not to but I can get a little obsessive with my drugs.  I ask lots of questions.”

I assured her that it was okay, that my job was to answer questions.  There were plenty of questions.  After awhile, she lightened up.  Maybe she began to trust me.  I treated her just as I would treat anyone else.  No prejudice against the crazy.  No snide remarks to the tech.  No hidden laughter.

One day, I looked out and there she was.   There was something not right. 

I walked out front and sat beside her.  “Are you okay?”

“I am crazier than Jack Nicholson today.  I hate days like this.”

“Oh,” I said.  What do you say to that?

          “You can’t see him, but that dumb sunuvabitch keeps telling me to do stupid things.”

“Are you having a schizoid episode?”  That response was weak, but this doesn’t happen every day.  I have suspected other people at times, but this was the first time that a patient reported directly that she was having hallucinations.

“I am really crazy today.”

I didn’t know that crazy came like a bad hair day.

I asked her if she needed to discuss her medication with her psychiatrists.

“There is nothing they can do.  I can’t afford the good medicine.  I’m in the doughnut hole.”

The Part D shame.   A right wing slanted committee in bed with Big Pharma and the insurance companies wrote the Part D bill.

She explained that her hallucinated person was forceful, clever and, get this, more real to her than I was.  She had learned what was which and who was who.

What do we do as a culture, a society?  What can we do as an individual practitioner?  Will voting right help?  Or do we just look away and think about the hard-to-get squash court reservation after work? 

I think it is time that I settled up with you guys.   The memoirs I share with you almost always portray me in a good light.  They are all spot on accurate and factual.  I enjoy letting you in on my druggist chronicles.

The genuine, actual and authentic stories that make me look bad, I don’t tell very often, but the reality is that there is a Mister Hyde in JP.

Office Depot “screwed the goose” on an order that was already two weeks late.  I demanded that they fix it by giving me the “goose that they screwed”  for free.

First, I worked the Assistant Manager over well enough that she asked me to leave the store.  Was I inappropriate?  I don’t think so.

Then, I talked to the store manager and reminded him that when I buy HP Laser Printer cartridges I usually spend over $500.00 at a pop.  I told him that I can get the cartridges from HP over night FedEx.

The question only amounted to a little over twenty bucks.  I got the “goose” for free.

The other day, at work, a guy standing by the register hollered, “Hey you!  Do you actually work here or do you just stand back there scratching your ass?”  He thought that was a good show of his manhood for the sluttishly bikini garbed out-of-town tourist trailer trash that he had picked up on Stewart Beach.  She hung on him and was giggling so hard her fat shook.  Get his nose too wrapped up in this babe and he’d suffocate to death.

He was at the register.  He did not need a prescription, but I recognized him.  He was a regular and had actually asked my advice in the past.  He wanted me to ring up the crap in his basket.

So…. I did it.  It was painless, but I was getting irritated at his act.  Make- jokes-about-the-pharmacist-so-he-would-be-sure-to-get-laid Tuesday night.

Pillow talk in the 1960s Beach Side Motel.  “What a jerk that pharmacist is.”

I knew that he was going to pay for his Coca-Cola, snacks and condoms with an American Express card.  So, I made sure that when the spot came for his billing Zip Code, I put it in wrong.

“Oh, man, I am really sorry.  I put in 77500 when it should have been 77550.  What a dope I am.”

“Well, do it right, man.”  He kissed the girl and nuzzled his mouth against the skin of her neck.  “Well?”

“Well what?”

“Put the number in right. 77550.  Okay?”

“I can’t, man. Do you have another card?”

He stuttered, “Um, uh, well, not with me.  Why another card?”

I shrugged.  “Am Ex believes that this card has been stolen.  It is done for the day, maybe longer.”

“That’s what CVS said too,” the young woman looked at me.  “What am I going to do?”  She was biting her lip. 

At first glance the prescriptions looked normal.  Pantoprazole 20 mg and Trimethoprim 100 mg.   Both indicated Disp 60.  What she wanted was the price.  I stopped at the Protonix 20mg.  Why bother pricing the trimethoprim?  I didn’t think she could afford the first Rx.

“Listen,” I said, “If you can’t afford that, you can buy omeprazole over the counter and the store brand is on sale this week.  You can call the doctor on Monday and discuss the medications he wants and how they fit in your budget.”

Ever helpful, JP.  When am I going to wise up?  It takes time and some effort to actually try to assist a person who is asking for help.  And, I really do try.  Especially when the matter is price.  These are tough times and people often just don’t have the money.

A boy, about 14 years old, was sent by his aunt for a packet of 8 tablets of Zantac 150mg.  I showed the kid the store brand and explained that she could get 24 tablets for only $2.00 more than the Zantac.

For this young man, it was a no-brainer.  He bought the private label version of Zantac.  Right about the time that alligators were up to my ass, I get a phone call from the aunt.  She tried to work me over, but I was too busy to listen.  She pissed me off.  No trust.  No sense.  I told her to send the boy back and we’d make an exchange.  A half dozen other similar incidents about price last evening and the customers thanked me.

Back to the pantoprazole.  “You can’t change it.  My baby has to have that.  Nothing else.  It is what they gave him in the hospital.”

Egads!  The prescriptions were for a 2 month old.  Had I gone beyond price, I would have looked at the Sig and would have known.  The dose was tiny.  The doctor, however, did not indicate that she wanted liquids.  She didn’t say 20mg or 100mg per what ml.  I explained that we could not compound these two prescriptions, but I could send them off to a compounding store in Houston.  That is what CVS told her, but apparently I was not dismissive as the CVS RPh had been.  I told her the doctor could have written discharge prescriptions to be filled at the hospital before her baby was released.

I had to put up with the doctor next.  “Why can’t you mix those prescriptions?  You are a pharmacist, aren’t you?”

Now that irritates me.  Should I ask, “You’re a doctor, aren’t you?”

“Because we do not have pantoprazole powder or trimethoprim powder in stock.”

“Why not?”

I do not like “WHY” questions.  They indicate that the questioner does not trust me.  In this case, it was the young doctor using a trial lawyer’s trick.  Put me on the defensive.

I did not bite.  “Doctor, why couldn’t you have given this young mother a thirty days supply at discharge?  You had to know that retail pharmacies do not do specialized compounds such as these.”

“I asked you a question.” 

What?  Did she think that I was on the witness stand?

I said, “about that discharge supply, doctor.”  Is this where I should have said it, “You’re a doctor, aren’t you?”

“What about it?”  She was huffing and puffing.

I said it gently, “It is too late now isn’t it?  You can’t go back.  This baby may have to go without.”

She ended the conversation abruptly.  Her ass was grass and she knew it.

Answer this question:  Why do I believe that most pharmacy students are indifferent to the state of the “JOB” of working in a retail pharmacy?  Why does it look as if they are not the least bit challenged by the working conditions that prevail?   Most of these people have at the least 50 years with their feet on a pharmacy floor ahead of them.  Is it the sign on bonus?   Is it the student loan they need to pay off?  Is it that they just do not care?

Or do they just think that they are bullet-proof?  They see that 50 year old preceptor walking with a limp as the end of the day closes in and cannot even imagine that what has happened to her after all of those years on her feet can happen to them.  Kids can get by on a salty snack, a Snickers bar and a Coke, but do it for 2 decades and tell me what it is like.

Twelve hour shifts!  It is getting to the point where the 50 year old preceptor won’t be able to do it anymore.  The 27 year old?  String a few together and get the really big bucks. 

Can you spell V-E-G-A-S?

Is the average student’s dorsal lateral prefrontal cortex still not fully developed?  The cortex is where the ability to see consequences for actions lies as well as impulse control.   Twenty four year olds are still like teenagers in many respects.

It is too bad that the pharmacy schools do not address the state of the “JOB”.   I don’t think it is enough to prepare these students to practice the “High Art” when in real life, they are expected to work the “Low Art”.  If you don’t know the difference you are in a terrific job or you own your own store.

The Pharmacy Alliance is dedicated to dignity, self-respect and integrity in the “JOB” of working in a pharmacy.   I’d think that most students might want those attributes in their future job.  Only a handful of students have joined and future pharmacists are outnumbered 2 to 1 by technicians.   This evidence is not anecdotal.  This is an accurate ratio.  Two techs for every one pharmacy student.

 The annual dues for both are way less than dinner, drinks and a movie.  The dinner being at the pizza joint and the drinks draft beer.

Students can see veteran pharmacists yawning, “Ho Hum”.  They can see the old hands taking their paychecks and not considering that they have a duty to both the profession as well as themselves bothers me.  The experience RPhs must take some responsibility for the lack of awareness among the students.

If you are a student, you might want to consider that there is something to fight for.  It might be good to get some steel in your spine because, listen, you are going to need it.   Your career starts now.  You cannot escape.  Give up childish notions. 

My Dear Independents.

There will be enough business for you in the “baby-boomer” decades ahead.  You gotta change your paradigm or the goose will be screwed. 

You will never, ever make AWP + $3.75 on PBM claims.   That was what PCS and PAID Prescriptions paid in 1966.  It will never be that way again.

Your paradigm absolutely must be that you get paid for pharmacy services.

This will NEVER happen with the current model.  NEVER!

The first, best step is to give up being the hero of an Ayn Rand novel.  Practicing Rand’s religion “Objectivism”  is not possible for an independent pharmacist in the 21^st Century.

Your best bet is to take the pittance that you will get for each Rx and pay your techs.  Maybe even the light bill. 

Gear up for making your living by providing pharmacy services.  

There is cash money to be made.   Clients will pay you for your expertise.

Counseling, MTM and immunizations will make money.  You can make a living, just as the doctor, ARNP or PA will make a living by using your knowledge.

I believe that SINGLE PAYER will be the model that will reward you.  If the PBMs and the insurance companies are allowed in the picture, they will just continue bullying you. 

Go ahead..Scream at me, “It is SOCIALIZED MEDICINE.”  So frikkin what?

Can’t you see that the PBMs have you by the balls and they have been increasing the squeeze for the last two decades?  So, just get them out of the picture.  All the insurance companies do is move money.  They take in $100.00 in premiums and shell out $80.00. 

That $20.00 provides NO medical care whatsoever.

A single payer administered by the Feds will give you fees for service.  The Feds are used to doing this.  Do your homework.  Don’t mention Canada to me.  The Canadians spend a little over $3,000.00 per person per year for medical care.

We spend close to $8,000.00 per person.

I do not care what you thought when you bought the store.  Most of you are not scions of  industry.  You are just making it.  Single payer puts service on top.  The end of Wal-Mart.  Single payer will make you a professional again.

Here is what Barack said when he was still a State Senator.  Call him.  Ask him why he changed his mind?  Is the insurance lobby that powerful?

STATE SEN. BARACK OBAMA: I happen to be a proponent of single-payer universal healthcare coverage. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent—14 percent—of its gross national product on healthcare, cannot provide basic health insurance to everybody. And that’s what Jim’s talking about when he says everybody in, nobody out: a single-payer healthcare plan, universal healthcare plan.  The “Jim” Obama is referring to is Jim McDermott, a legislator from Washington State who is well known for advocating for the citizens of the USA.

Take a look at the new page entitled “MEDICAL-Industrial Complex.

Consider this while you are damning Walgreens to the dungeon where all evil and divisive employers end up.  ENRON FIELD.

The baby boomers are those people born between 1946 & 1964. 

The first of that group just turned 62 in 2008.  There are about 20 years to go and IT IS CUMULATIVE.

In 1997, there was a boomer turning 50 every 7 seconds.  4,000,000 will turn 50 in 2009

In 2009, the boomers are those Americans between 45 & 63 years old.  The BOOMERS are still relatively young.

The pharmacy industry is close to breaking already and look what is coming. 

Here is a 1996 figure. 76,000,000 between the ages of 32 and 50.  If they are still alive,

that was 29% of the population in 2006.

The older you get, the more prescriptions you will need if we continue the medical model of treating sicknesses rather than preventing them.   Remember.  The number of boomers is CUMULATIVE.

The BOOMERS are still relatively young.  Wait a few years and you will see the pay off for POWER. These people (The Boomers) will not “age gracefully” as their parents did.  Why should they?  They eat better, they exercise, they meditate and they have the wonders of pharmaceuticals.

What they want is to stay vibrant, energetic, youthful and sexy for the entire ride.  That ride will be longer and longer.  That means an impossible to forecast number of prescriptions.

This is a “No Brainer”.  Walgreens and CVS and Rite-Aid (if there is one) cannot build enough stores because there is not going to be the professionals to staff them.

Walgreens is prescient.  They see what is coming and they want a piece of it.  They are not sitting on their hands,

The problem for me is the mean way they are handling their employees.  There has to be a better way to transition.  If they hurt too many people, a very angry gorilla may swallow them up by choosing to practice pharmacy elsewhere in the future.

Drug Topics magazine “scooped” the pharmacy magazine industry and reported on Walgreens’ POWER before anyone else had a clue.  Drug Topics is THE news magazine for our industry.  I am not going to explain POWER to you.  Go to the Drug Topics home page and put “Walgreens POWER” in the search spot.

Since the Drug Topics report, there has been a ton of talk on the blogosphere and via lightning e-mails about POWER.  Many of the writers are “crepe-hangers”.  They see the end of pharmacy as we know it.  They see technicians doing all of the dispensing and I say, “Why not?”  There are better things for pharmacists to do.  Like “Patient Care”.

They see pharmacists out of jobs and the ones who are still working being chained forever as slaves in the galley.  Sweaty, starving, exhausted and dangerous.

I do not join the “doomsayers”.  They have been predicting disaster for decades.  I testified at a meeting of the California State Board in 1972 or around there.  The big question was:  Does California allow technicians,  recognized by the state, to work in the pharmacy.

Omigod, it was the end.   The Retail Clerks International Association (union) brought in three lawyers from New York.  The CPhA screamed about pharmacists put out of work. 

 Well, my friends, you know how that turned out.   Without technicians, we would be doomed.   My testimony was in favor licensing technicians.  My eye is good.  Trust me.

POWER is a brilliant opportunity to free up pharmacist time at the “Prescription Mill” to actually do professional patient care duties.  Like- Counseling.  Like saving lives.  I’d give you odds on a bet that patients have died due to lack of counseling.

With pharmacists having the time to counsel, I say that NOW is when the 50 State Boards of Pharmacy give up the farce that is the make-believe enforcement of counseling laws.  If the pharmacist has time and does not counsel, then it is on her and her employer.  They both must be cited.  They both must be fined.  Both licenses must be suspended for seven days.  Let the pharmacist cool her heals watching Ellen and the pharmacy be closed for seven days.  How is that?

Washington State has been a bellwether for decades.  The technicians in Washington had been licensed for years on that day in California.  Washington will be the first to start nailing pharmacists whose noses are so stuck to the prescription mill that they don’t even look up.  After Washington sets the standard, all of the dominos will fall… with certain southern states holding on until they have no choice.

The Pharmacy Boards are mandated to protect the public from you and me and what we do.  They haven’t listened when we told them that “A TIRED PHARMACIST IS A DANGEROUS PHARMACIST”. 

It is imperative that we start making demands NOW.  For how to get to your state board.  Go to this blogspot.  This guy has links to all 50 boards in the right hand column.

http://www.pharmacistdaily.blogspot.com

You are professionals.  Start acting like it.

There are some incisive comments on the page titled “Walgreens POWER”  To put them all at the same spot, I’m going to copy and paste them on the comments here.  JP

I think that some of the readers of what I write have a faulty picture of old “Jay Pee”.  I usually write about my successful transactions with my patients/customers.  On occasion, I’ll tell you about the trouncings I take.  There are people who just are not charmed by Jay Pee’s efforts.

I am a risk-taker.  I take chances with people.  It usually works out.  One of the things I do is touch.  In the puritanical US of A, we don’t touch enough.  Touching gives a comforting message.  Go to southern Europe and you get kissed and touched more in one day than in a year in Vermont.

Two decades ago, I got creamed.  My eidetic memory can even recall her fragrance.  It was Diorissimo.  I remember the Lily of the Valley.  A good-looking, but plain brunet asked my help in the feminine hygiene area.  While I was stressing to her that regular douching will kill the bacillus, the good bacteria, I lightly touched her forearm.

She went ape-shit.  I apologized and quickly retreated.  I was told by a good customer who had observed the scene that this attractive brunet was an ex-Roman Catholic nun who had put up with regular sexual abuse from a priest.  I’m still going to touch.  Especially when I am reassuring a patient about her illness.

The Friday before Mothers Day, I was assured that I still have it.  I can’t see it when I look in the mirror, but a customer made my day.

I always make eye contact.  I always smile if that is appropriate and I will always frown if that is what the transaction requires.

Last Friday, I made eye contact with this guy and we laughed about something.  I touched his forearm and gave it a squeeze.  Then he invited me to go deep sea fishing with him over the weekend.  We would go way out in the Gulf of Mexico, spend the night on his boat, fish a little and come back on Sunday.

This guy is as gay as Elton John.  He is always color coordinated.  He gives girly-girl body messages better than any woman can.  He is 5 years younger than me.

I told him that I had to prepare for Mothers Day.

“Oh….You are lucky that your mother is still alive.”  He batted his eyes and moved his shoulders in a manner that no man could replicate.

“My wife,” I said.

“Oh No, I didn’t know.  You are…”

“…I am straight,” I said, “But, man, thank you for the compliment.  I am honored that you would find me to be attractive.

“Oh…yes.  If ever……”

I have a joke that makes most customers laugh.  When the copay is really low, like $1.20.  I step back in mock horror and announce.  “You are robbing us.”  Everybody has fun laughing.  Almost everyone. A grouch bucket just said, “Shut up about my copay.”

Late last night, I filled a trazodone Rx for a 67 year old woman.  I had her spotted as a woman distressed.  Her blonde hair was stringy and for some inexplicable reason, she had a pencil thin strand rubber banded so it hung over her left eye.  She asked me if the drug is for depression.

When I gave her the Rx, I said, “So.. you are down in the dumps?”  Of course, I made eye contact, but I did not smile.  You don’t smile when she is depressed.

She gave me a blank look.

“That means…you got the blues, the Galveston blues.”

“I do have the blues.  My son doesn’t want me to live with them anymore and the apartment is like solitary confinement.”

Of course, I touched her arm and said, “Well this is a good chance to make new friends.”  That was the wrong thing to say.

“I can bake the best blueberry muffins,” she said, boring me with her eyes.  “They will melt in your mouth.”

“I’ll bet they are delicious.”  Oh oh, I was feeling a little tense.   Please, I thought.  No, please do not invite me to your apartment.

“Do you like Lou Rawls?”

“I do enjoy Lou Rawls.”  I cringed. 

“We can listen to Lou Rawls and I’ll bake the muffins.  I like Cognac.  Do you like Cognac?” 

This was killing me.  She had gone from a face that said death-is-coming-soon to classic I-might-get-laid-tonight  body language.

I took a deep breath and lied to her.  “I feel like I am getting the Swine Flu.” 

“Do you feel sick?”

What was I thinking?  “My body aches all over and I just need to go home and get some sleep.”  I immediately regretted it.  Someday I’ll have to tell her the truth, but last night, I did not want to add more weight to her blue mood.

It is all about balance, you guys.  My shtick usually makes me a winner, but there are times when I plummet off the high wire.

Take a chance, you guys.  Relax.  Be yourself.  Connect with these people. 

When Vladimir Horowitz, the brilliant piano maestro was asked how he could play so perfectly, with no mistakes, he said, “I always make mistakes.  The secret is to blend the mistakes in so no one notices them.

Balance!  There is an old Japanese proverb:  Even monkeys fall out of trees.