Let's Have a Chat about Asshats Shall We?

Okay. Let's be frank. We all know people who in the privacy of our minds (or out loud) are serious jerks. Our world is populated with these types of idiots--whether it's the sour-faced cretins who are abusing the cashier at the grocery store or the bigoted morons we encounter on Twitter. For convenience's sake (and because I like the word) let's just lump them all together under one linguistic aegis and call them asshats.

And before anyone complains, 'ass' can be found in the Bible and 'hat' is a lot nicer than 'hole'. Basically I'm calling these asshats haberdashery for a donkey, so slow your roll. 

When I tended bar, I dealt with asshats every night. Some were willfully rude; others didn't seem to have the slightest clue they'd been nominated for the asshat club. Every shift I worked, asshat relations were a huge part of my job. For people who exist upon the income they receive from tips, being able to handle the asshat had serious repercussions. Now, an asshat who was a moderate drinker I could usually deal with. The real problem came when the asshat in question drank a lot. Once an asshat gets a buzz, his proportionate asshattery grew accordingly. 

And since the biggest asshats at my job were related to the owner of the bar, my ability to relate to them was essential. 

For a while, I had to play along with the asshat games. But once they reached a certain point, I had to put my foot down. Coming behind my bar? That was a no-no. Driving while trashed? Equally a no-no, as I proved several times taking asshats home, calling them a cab, or calling my boss when his relatives were the asshats in question. For the most part, my asshat relations were fairly successful. Of course, the asshat has the final word. Annoy the asshat too much and he wouldn't tip. 

But if someone was being a hardcore asshat, I didn't really care. And if the asshat refused to play along with my 'this is my bar shift, and you will not screw it up' mentality, there was always another option. Nothing is more gratifying than throwing an asshat out of a bar. Nothing. Once I pulled a straight up Dukes of Hazard slide over the bar to break up a fight between eight guys. Finally got them all in the parking lot and a regular called the cops for me. Got hit full in the face,but since I was wading into the fight to pull someone out by their ankles it was my own fault. 

What I hadn't counted on was the asshat-in-chief getting into his car and trying to run me over. 

But then again, I have a high percentage photographic memory, and his license plate was fairly easy to remember. The cops picked him up three blocks away, thus gratifying the 'send the asshat to jail' mental fantasy I had silently daydreamed about for hours. 

Unfortunately, the natural habitat of the asshat has evolved in recent years. Instead of wandering the wilds of the outdoors, now the asshat has taken to living in his mother's basement or a rented double-wide, where he stalks his prey online. He's lurking right now on your Twitter feed, waiting to pounce on the unwary. 

I am rarely unwary, and having a good vocabulary, a fast WPM typing speed, and the ability to think on my feet has brought me into conflict with this most elusive breed of asshat. Unfortunately, the internet doesn't require an IQ test before someone is allowed to participate in social media. Or a spelling/grammar test either, which I find reprehensible. And while you can prune your contact list to people with merit, you cannot prune your contacts' lists. And that's how the heavily-disguised asshat slips into your feed. Someone says something objectionable, and you end up getting into a flame war on Twitter with some asshat whose political memes are desecrating your feed. 

Allow me to warn you--the asshat is incapable of learning when they've been beaten, and will flame on long after he'd actually run out of gas. Then all of a sudden, when it's obvious that you have won, the asshat resorts to name-calling of the worst order. I can't even tell you all the creatively spelled curse words that have been directed at me online. It's like they know that because I am a writer/editor, every ghastly misspelled degrading term impacts me just that much worse. Strangely enough though, the asshats who don't know the different between 'your' and 'you're' always manage to spell 'bitch' correctly. 

It baffles me.

There's a particular asshat on my radar right now who is a caller on the Paul Finebaum show. He is only capable of carrying on flame wars when they're one-sided--because the cowardly asshat blocks anyone who disagrees with him. So he spews forth these monologues denigrating good people that I personally like, and is fundamentally incapable of tolerating anyone who disagrees with him. As I am allergic to homophobic misogynistic bigoted racist pigs, I've been blocked for a long time. But that doesn't stop him from trashing me all over the internet. This asshat's life is so empty that all he can manage to do is spew forth poison online about someone who can't even see it firsthand--and call a sports talk show to plug Donald Trump. And his  wholly imaginary past. 

Which brings me to the ultimate point about asshats. Regardless of whether you encounter them in public or online, the asshat is fundamentally a very sad,lonely person. Their sole empowerment is acting like an asshat. Sitting down at that keyboard is the high point of their day. Because they have nothing positive to offer themselves,all they can offer is negativity to the world in general. So in the end, stepping on an asshat is kind of akin to stepping on a cockroach.

Kind of gross but wholly satisfying. 

Turning Into a Self-Published Author--Part 1

Okay--I'll admit it. I've been spoiled. Throughout my career, I've always had a publisher who dealt with the cover art, the layout, the formatting, the uploading, some publicity. But now that I'm reissuing my first fantasy series The Asphodel Cycle, I have been forced to turn into a self-publishing author. 

And yes--I have a leg up because I've been a publisher--as in I published other authors' books. My experience first at AMP and then at Musa gives me a unique perspective on everything a self-published author has to do. 

The difficult part for me has been separating the authorial responsibilities from the publishing ones. 

Here's the deal: if your work is picked up by a small publisher or a big one, they are the ones spending money for all the things you need. And I know how expensive those things are because we were the ones paying people to design the cover or format the ebooks. As a self-publisher, you want your books to compete favorably with publisher-released titles. That means that you--and I--have to spend money to make that happen. And nothing is more important than cover art. 

Do yourself a favor. Unless you have a lengthy background as a book designer, don't try to make your own cover using Paint and Photoshop. Just...don't. Go to a reputable cover artist and just fork out the money you can afford to get a professionally designed cover. If you don't, you're just throwing your book away down a big black hole. Your cover art is the most important promotional tool your book has. It's the first thing a prospective customer sees, and is the deciding factor as to whether they click through to your blurb and sales page. Do not skimp on the cover design!  There are artists out there who will design a good cover for under $150-200. Go to self-published authors you know and find out who did their cover.  

Ditto and double that for interior layout, design, and formatting. If you want to spend a frustrating 48 hours trying to detangle the formatting directions each separate e-reader requires, knock yourself out--and consider yourself lucky if it ONLY takes 48 hours. Or, open up your wallet and go to a reputable design firm--I use KMD Designs, which is run by my former Musa partner Kelly Shorten. Not only are her designs incredibly solid, but mistake-free. And her prices are very, very reasonable--far less than I had originally anticipated. Check out their website, prices, and portfolio here.  Or find someone else that you are comfortable with who possesses the knowledge you do not. It's well-spent.

But all this notwithstanding, the biggest obstacle for many of us I think is on the promotional end. My first release, The Reckoning of Asphodel, comes out in a little over a month. So I am going to have to take the 12-15 hours a day I've been spending writing and use at least half promoting my books. And when the sequel series comes out this fall, I will probably have to spend more.  

The main thing you HAVE to do in order to promote your self-published books is to create an online presence. Yeah, I know--everyone tells you that. But it's essential--Twitter, Facebook, Pinterest, Instagram, blogging, participating in online activities, Goodreads, Amazon author page--all these things are cogs in the wheels that sell your book. I DO NOT MEAN to hop on Twitter 4-5 times a day and post a plug for your book. I'm an author, and I mute other writers who do that on my feed. So don't be an obnoxious 'buy my book' whore. Create daily content--like, say for example, a blog--and use your social media presence to promote THAT. That sends people to your blog, where all your book information should be prominently displayed. 

These preliminary steps should be fairly automatic for any writer about to launch onto the ocean of horror known as self-publishing. But if you do it right, if you invest in your books and create that online presence, you can at least get people to LOOK at your book. And if they don't look at it, they aren't going to buy it. So get busy! Get all those bits going before your book even hits the market. And then check back as I dig deeper into the process in a future post. 

The Crazy World of Chronic Pain Patients

So, I am a chronic pain patient. Thanks to an automobile accident in May of 2002, I now have a broken artificial disc in my spine that is prevented from severing my aorta by a spinal fusion. The rest of my spine is crumbling now as a result of the stress and the previous surgeries. Obviously, this is a painful and constantly deteriorating condition, and one that I deal with on a daily basis. As a result, I am a patient at a pain clinic here in Ohio. 

I absolutely love my pain management doctor. He is sympathetic and very good at what he does. But thanks to the growing restrictive laws regarding the treatment of chronic pain patients, his ability to help me is being hampered by the government we both pay taxes to. Right now, I'm going through something that many chronic pain patients have to endure, and I want to talk about it freely and honestly. Because for those of us in REAL pain, the laws have started to impede our ability to get the help we need. 

To start off with, the list of medications I have been on just to keep my pain at a tolerable level is fairly extensive. I have been on methadone, which is a slow-release pain relieving narcotic for over 8 years. Add to that dilaudid, oxycodone, neurontin, meloxicam, amitriptyline, mirtazapine--and you get an idea of what I'm talking about. Now you guys need to understand something here--all of these medications can only get my pain level down to a 6 out of 10 on a very good day. There are many days when I cannot sit up, or walk across the house. And in order to get those medications, I had to sign a pain contract with my doctor--a contract that outlines what will happen if my pill count is off or my blood/urine random drug screens are off. 

What happens is that I get discharged from the practice. 

So, flash back to December. I had been discussing with my doctor my desire to get off the methadone entirely. Methadone is insidious. You don't FEEL drugged when you're on it--which, as a writer, I liked. Methadone was the first slow-release medication that had actually helped me. BUT, last spring I accidentally knocked my last week of meds into the toilet, and then I found out exactly how addictive that medication is. Methadone withdrawal is NOT fun. It's agonizing. So at my next visit, I told my doctor I wanted to wean off of it. 

He wanted to do a pair of final procedures first to see if they helped. They didn't. And so, at my December appointment, he agreed to wean me off it. 

Enter the complication. 

Before that visit, I'd been deathly ill with a sinus infection that kept me from keeping anything down. In order to make sure that I kept down the methadone, I stopped taking my other medications. You know--having gone through a week of withdrawal just six months before, I didn't want to go through that again. At my doctor's appointment, I told the nurse I'd been sick--but neglected to tell my doctor. And a few weeks later, a couple of days before I needed to call for refills on my support meds, I got a letter from my doctor informing me that my urine screen was off and therefore they would not prescribe me any controlled substances anymore. 

This was pretty devastating. I was weaning off the methadone, but it wasn't going well. And now, I couldn't get any of my support meds? 

Oh God. 

You see--when a doctor cuts off  a patient or tells them he's going to take them off their pain meds, a lot of the patients go absolutely nuts. My doctor has a form everyone has to sign now, stating they aren't going to assault the staff! No lie--just this week a big burly guy went after one of the nurses and then my doctor he was so enraged. Stupid. 

Because of this, I knew better than to call up and yell at the staff. It would have accomplished nothing. So I discussed it with my husband and decided to just tough it out until my next appointment. And then I spent the worst couple of months in my life. January and February are pretty much a blur. I stopped eating, stopped sleeping, stopped pretty much everything. I spent hours just thrashing around on the bed or the couch, desperately trying to condition my body to get accustomed to the lower dosage of methadone. I made it halfway--cut my intake to half of what it had been, but couldn't get any further. I could not make the jump to 1/3 of a dose. 

I ended up in the hospital last week, severely dehydrated and having lost over 50 pounds since my last doctor's visit--and got a pain shot that let me sleep for a whole four hours before the withdrawal started again. But, I persevered. The ER doctor called my doctor, and they prescribed me medication to help with the withdrawal symptoms. And so, when I went to my appointment this week, my doctor and I were able to have a good, constructive conversation about my treatment--and when he discovered that I'd been sick and that was the reason my screens were off, he relented and readmitted me to his practice.

He also told me I was one of the few he would do that for. Why? Because in the last four years, my screens have never been off. Neither have my pill counts. I have always followed my contract to the letter and he knows that. But I think, also, he was impressed. I had literally none of my support meds--medications for sciatica,  neurological pain, arthritis--the daily medications that help people like me without being narcotics. I was going through severe withdrawal. And I made it all the way to the last week before my appointment before he got a call. I never called his office and cussed out some poor girl who answered the phone. And at my appointment, I was my usual self--and we talked as we always do: with mutual respect and honesty. 

He explained to me that both the state medical board and the DEA were analyzing his records. Just a couple of weeks before, the DEA had been in his office regarding one of his patients. After I left his office, I started to think about that. 

THE DEA AND THE STATE/FEDERAL GOVERNMENT ARE MONITORING OUR MEDICAL RECORDS FOR THE PURPOSE OF HARASSING PAIN MANAGEMENT DOCTORS. 

What the hell is the DEA doing looking at my medical records? That's outrageous! Our medical records are supposed to be PRIVATE, right? According to the HIPAA no one can access my records without my permission. But, once I started digging, I discovered some pretty horrific exceptions. For example, take a look at this: http://www.thehealthlawfirm.com/areas-of-practice/pain-management-and-dea-defense.html

Pharmaceutical manufacturers and distributers keep track o f the narcotics they sell and to whom they are sold. This is particularly true of narcotics and other medications that are routinely over-prescribed and abused, such as oxycodone, hydrocodone, Roxycodone, Percocet, Xanax, and other such medications. They will usually report a pharmacy or physician that orders a larger amount of any of these drugs that usual. Drug chains and manufacturers also track the numbers of various drugs that are prescribed by various physicians. They will usually report a pharmacy, clinic or physician that orders a larger amount of any of these drugs than is usual for their customers.

If an "inspection" or search and seizure is performed on a physician's office, a pain management clinic or a pharmacy, it will usually be after an investigation has already been conducted by both state licensing authorities and the U.S. Drug Enforcement Administration (DEA). An investigation will usually be opened based on one or more complaints that have been received from patients, next of kin of patients, pharmaceutical manufacturers and distributors (who report large quantities sold), competitors, local surrounding businesses, or local law enforcement authorities.

Physicians, pharmacists and staff members may be arrested during such a visit. There will usually be emergency suspension orders (ESOs) that will be served by the DEA to suspend DEA registrations and numbers of pharmacists, physicians and clinics. Emergency cease and desist orders (CDs or CDOs) may be served by state licensing bodies (such as the Department of Health or the Attorney General's Office). Orders to show cause (OCs) why a DEA registration should not be revoked may be served. An emergency suspension order (ESO) to suspend a state license may be served if the investigations or proceedings have already progressed to that point; however, usually this will come later. Arrest warrants may be executed and people arrested. This will almost always have been planned and decided ahead of time.

Uhhh...so that's the back door the DEA uses to get to patient pain records. Based off the report of a disgruntled patient or a manufacturer who tracks where each batch of pain meds are sold, the DEA and state licensing authorities can launch an investigation and get into the patient records either through the pharmacy OR the physician's records. From the same site:

In almost every one of these cases, either the DEA, the Department of Health or the local law enforcement authority used undercover agents posing as patients to make appointments with the physician, agents usually wore a wire device, and gave the physician false information.

Yeah. In other words, entrapment.

See here's the thing. I am very well aware that there are both patients and doctors out there who are trying to skirt the law. Portsmouth Ohio, not so far from here, is an infamous location for "pill mills" and that's very well known. But the majority of chronic pain patients are like me: their bodies devastated by injury or genetics, in constant, unrelenting pain, who require the strict regimen of a good doctor to just function on some level every day. And we are the ones who are suffering from the illegal activities of the few.

My pain management doctor is a wonderful guy. I trust him to do the best he can for my care. And because I wanted to get off the most dangerous medication in my regimen, he trusts that I'm not a 'doctor shopper' or addict looking for a fix. That's why our relationship works. But with the DEA and the state breathing down his neck all the time, his hands are slowly becoming tied in how he treats his patients. Think about it: he makes one mistake, one misjudged character, one manic depressive who tried to commit suicide, and not only he but his ENTIRE STAFF gets arrested and charged as criminals. CRIMINALS.

Maybe our country would be better served if the DEA went after the REAL problem here. I am not the problem. My doctor is not the problem. The real problem is the DEA's inability to have any effect upon the REAL drug trade, and so they are focusing on the minutiae of chronic pain management. Because when a GOOD pain doctor is arrested, then HUNDREDS of chronic pain patients like myself are doomed to the agony of suffering without relief for their pain until they can find a new doctor who is willing to take them on.

I've been through that. My last pain management doctor was arrested because he was over-prescribing...to himself. I got the phone call three days before my appointment that he had lost his license, and they gave me no help in finding a new one. Thankfully my family doctor took over until I was able to get in with the doctor I have now. It's a very agonizing kind of panic, when you're looking into the bottle you need to survive and knowing you have three days to find someone willing to help you out. It's the kind of thing that makes a wholly normal person act like a drug addict--not for the fix, but in terror of what will happen to their body once that last dose is processed. And for those of us on methadone? That cold turkey withdrawal lands us in the hospital.

So there's the story of my last couple of months. It's not a pleasant story, but there are lessons to be learned through it.

And damn...my butt looks good. Wouldn't recommend the weight loss program to anyone, though.