Chemistry.

    So, I took a Benadryl.  And, it's not so much that I'm dealing with allergies (I'm not), but more to do with sleep (I can't).  The way I see it, it's got the same active ingredient as Tylenol PM (diphenhydramine), and considering that I'm already taking Vicodin, which has the same active ingredient as the Tylenol portion of that little pill (acetaminophen), and boosted with a delicious morphine knockoff (hydrocodone), I figure that I should be a reasonably painless, drooling 210 lb. puddle of self-face-licking sludge in about thirty minutes.

    Now, why can't I sleep?

    Well, normally, at hours such as these, I'd say it's either he product of some sort of ache or some sort of major caffeine jag; however, tomorrow, I have a rheumatologist appointment, and considering the bleak state of my health care status, I'm a little pissed off at not only anyone in a white coat, I'm also thinking about getting a little stabby on the nice parking lot attendant in a mad, guilt-by-association sort of thing. 

    Nonetheless, I'm not about to kill anyone, but as I lay in bed tossing and throwing myself around on the mattress like a freshly landed carp, my mind inevitably ran down the variant conversations my doctor and I will inevitably have, and a boiling little stew of pent-up rage began to bubble inside.  For the last several years, my doctor, who I am sure means well somehow, has been a doddering, old, broken record of repetitious medical insanity.  I go into the exam room, she taps on the door, she comes in, and from there, it's always a Gitmo-esque ritual of squeezing every freakin' joint to determine which hurts (almost all) and which doesn't (a couple that will once she's done with her twisting and yanking and pounding). 

    In most worlds, you'd think that would be enough hell for one day.  Unfortunately, I don't seem to live in any of those worlds.  What follows after the bone-shattering manipulation can only be described as textbook insanity...  or, well, whatever book, text or otherwise, it is that states that the definition of insanity is foolishly trying the same thing over and over while expecting different results or outcomes.  And, she's done this for almost a god damned decade!

    After I get all tangled and twisted and yanked and mangled, she will try to suggest medications.  Actually, she will try to prescribe either Enbrel or Humira or both, and the conversation will go exactly like this:

    "Ive just faxed a prescription for Enbrel to your pharmacy," she will say as she has said every time I've seen her in the past fucking decade.  "I don't know why you haven't been on this.  It's supposed to work great.  You really should be on it."
    "Umm..." I will say.
    "Is there something else?" She will ask.
    "Enbrel isn't covered by my insurance," I will tell her in the slow, soft tone that I use when I am talking to a small, retarded child.
    "Is there a co-pay?" She will then ask.
    "Yes.  Sort of."
    "Well, then it has to be covered."
    "It's really no..."
    "If there's a co-pay, then you can get it and just pay what they don't."
    "We've tried thi..."
    "There's a co-pay!"

    Now, as much as I want to grab her by her hair and drag her, kicking and screaming (and probably bleeding), to the pharmacy with me and rub her face in the paperwork that says DENIED, I, once again, try to explain.  I try as I always try, and I say "I have a seven hundred dollar a month pharmaceutical 'allowance,' and what you are prescribing still exceeds that limit just as it did one year ago, two years ago, or five years ago!" 
    "You can pay the difference!"  She will then counter.  "If they cover the first $700, you can pay the rest.  What is that?  That can't be much."
    "First," I begin...
    "But there's a co-pay!"
    "First," I start over, "that's not how it works.  That's still not how it works.  If the medication costs more than $700, they don't cover it.  At all.  EVER!" 
    "Co-pay!"
    "If it's less than $700, then I pay some sort of percentage."
    "But, we have a person who is paid to know these things in this office."
    "They're wrong.  They were wrong the last dozen times I was in here, and they are wrong now."
    "You have stupid insurance." She will say as though I have some sort of a choice, and I will refrain from driving my fist through her face and into the back of her old, empty skull. 

    Of course, now, I am on Humira (just replace the word Enbrel above with Humira, and the conversation is the same).  Thankfully, as a result of the "altruistic" folks at Abbott Pharmaceuticals, I deal with them directly, and all my idiot doctor has to do is sign some paperwork, and it keeps from mucking up a monthly pharmaceutical "allowance" that would be exhausted with a single dose.  Unfortunately, it's started to lose its effectiveness, I think, or perhaps it's nullified by the brain-crushing insanity of being stuck in this endless and obtuse circle of medical insanity. 

    The thing is, I can't tell my doctor that my Humira may be failing because she will freeze up, and I will be cast back into the nightmare of having to, once again, listen to her ramble on about the glory that is the co-pay system, and I will be left with nothing.

    So, I can't sleep because I am sitting here trying to prepare myself for the myriad of permutations of the same god damned conversation that I've had every single visit for more years than I care to remember, and it is, in a word, maddening.