Thursday, March 28, 2013

Neurotypical Echolalia

She teaches "special needs" children.

It is hard work, to teach children with "special needs" she tells me. She says it is rewarding to help the ones with special needs, but the expression on her face does not support that. I know joy when I see it.

She wants more of the night lights. The large, round, dim ones. She said they like them. They...with "special needs".  They like to play with them.   We only have one to sell. Not enough for all the children that want them. The "special needs" children.

She mentioned her work with the "special needs" children at least 4 times in this uninitiated conversation. Most people that work with the disabled feel the need to repeat it. Perhaps it's neurotypical echolalia. Perhaps she needs to feel validation. She, the only one without "special needs".

Sunday, March 24, 2013

Art of Internal Gaslighting

Trigger Warnings: Extreme gaslighting, autism, abuse, bullying, unpleasant medical problems

I am smart, and I could do great things if only I had common sense.  So I've been told.  

Absent Minded Professor, Idiot Savant, Rain Man.  I've heard all of that.

I am a jerk.  I don't socialize much.  That is my fault.  If I would try I would find it easy just like everyone else.  But I don't try.  I choose not to, my choice, my failing.  Its because I'm a jerk. 

I am clumsy.  That is because I didn't play with other kids.  If I went out and played baseball I would learn to catch it.  If I would keep my eye on the fucking ball I would hit it and you wouldn't have to give up.  If I wanted to make those free throws, I could.  I wouldn't lose my balance if I would stand still.  If only I got off my fat ass.  If I did some push ups I could climb that rope.  If I lost weight I wouldn't tip my bike over.

I am a hypochondriac.  I overreact to minor illnesses and make things up.  Its my excuse to fail, which I have openly chose to do from birth.  I have been sick approximately zero times in my childhood.  If..  if, by some off chance I really was sick it was minor and I should have sucked it up.

I am a wimp, or sissy or wuss or any other ableist, sexist or homophobic slur you want to toss at me.  I get anxious in social encounters because I am a wimp.  I sweat profusely when it is over 70 degrees because I am a wimp.  I gag on food because I am a wimp, ( and also because I am a jerk for not eating something that someone made for me).  When mom died, you shamed me for seeing a counselor because I was a wimp.  I jump at loud sounds because I am cowardly wimp.

I am forgetful.  When I forget something relating to someone it is personal.  I personally choose to do it because I am a jerk.  If I forget to do something I was supposed to do, its because I am lazy. 

I am lazy.  If I would use my intelligence, my gift buried under my landfill of self created shortcomings, I would still be ok.  But I don't, therefore I am not.

I am naive.  You moved me away from the city, because I was too naive to go to school here.  I "would not have survived with the street kids".  Too trusting, too gullible.  If only I would wisen up and pay attention. .

I am an astute learner, and having mastered this craft, the art of gaslighting, I set forth into this world on my own at the age of 18 with hypocritical disdain not only for myself  but the world around me.  I saw my shortcomings and those of others as voluntary.

I tried to become a party animal in college.  I had many meltdowns, which I was able to pass off by claiming I had drank more beer than I really had, or claiming I had a massive hangover from all of the beer the night before.  I told myself I was just immature from lack of socializing.  I would figure it out.

I became depressed my second year.  I isolated myself, and mostly only attended quizzes and exams.  I passed the courses using only the books and the syllabus.  I actually got through that year, but this strategy began to fail me in my 3rd year as I began to fail showing up for even the mandatory.  I viewed this as personal failure.  I turned to no one for help because I didn't believe I needed it.

I also failed to keep up with my financial aid and ran out of money, so I had to quit.  I told my friends I was taking a semester off then never spoke to them again.  Told myself I would go back someday.  Told myself I did it because I was lazy.

I didn't dare ask for help at home.  I was grateful my family tolerated me.  I felt that they tolerated me out of loyalty to my deceased mother.  I felt that I reminded them of my abusive father (I am named after him).  They told me so on occasion.  I kind of look like a much taller version of him too.  If they loved me, they did it despite the fact that I was an immature, naive, lazy, forgetful, clumsy, wimpy idiot savant with an antisocial personality  (Their words which became mine).   Upon learning that I was not going to attend college next semester, they threw me out.

I survived in direct defiance of my supposed naivety.  Made it to the age of 27.  By this point I was starting to isolate myself again as I had 7 years before.  I felt sick and had crippling anxiety every day.  I quit my job, cut off my friends and lived off saved money for 6 months, doing nothing but playing Warcraft.  After washing those funds up, I moved out west into the home of my guild leader that had invited me to move out there.

I figured that I would finally learn to socialize out there and build a new life as far away as possible from the one I was currently living.  The social anxieties I experienced from college soon returned.  As did the workplace anxiety I was experiencing as I searched for and bounced around a few menial jobs.

I also began to feel increasingly weak and short of breath every day, as well as a lot of leg pain.  I chalked it up to being out of shape, anxious and not acclimated to the new climate.  It became more and more extreme, as I struggled to walk moderate distances, then walk up hills, then get out of bed and get dressed.  Yet I still pressed on because I did not want to be anymore of a disappointment than I already was.  And also, by nature, I was a wimp and a hypochondriac, it was probably a molehill that my weak mind contorted into the planet Jupiter.  

I learned I had a pulmonary embolism, generated from a Deep Vein Thrombosis (technical word for big blood clot)in my left leg that I likely occurred from my trip to California (I took the scenic bus route).  I learned this after taking myself to the emergency room.  I accepted that I could possibly be sick when I no longer had the strength to make the 20 foot walk to my bathroom  (I had to crawl), and that condition did not alleviate for over a week. I was told by doctors that I had lost 80% of my breathing capacity and odds of me not surviving another night were 66%. 

It was my fault of course.  A nurse even told me so.  I made poor lifestyle choices.  I was fat, and I play video games.  I was not a hypochondriac this time, but I was lazy.  And I got what I deserved.  I got what I asked for out of life.  I didn't need the nurse to tell me that, I already believed it.  I didn't need my family to tell me that either, I had proven it.

I had to return home, to the place I was cast out of 7 years previously for being too lazy and a weakling because I was too lazy and a weakling.  At this point, I am not sure who emotionally tormented me more, myself or them.  The opposite of being a wimp is being strong, so thats what I had to be.

I tolerated the pain of walking.  My left leg was permanently damaged from the clot.  It swells easily, and I get pressure sores.  Sores that grow and grow and grow when untreated.  I had to take 2 weeks off a few years ago to let it heal a bit after it got infected.  I saw the doctor a few times, found out where I could buy the medicated bandages he used, then began self treating it and went back to work.

I only took OTC painkillers for this, because I saw a prescription as a sign of weakness.  A few days after I transferred to a new store closer to where I currently live, a sore broke open and I lost about a half pint of blood.  Ambulanced off to the ER, I was kept in the hospital for 3 days, where my clotting and circulatory problems were Exhibit A for interns and med students who saw no problem in poking my wound at 4:30 am.  Upon release I vowed to keep my bandage tighter so it would not happen again and went back to work the next day.

In addition to a 50+ hour work week, I took up weightlifting and distance running in this condition, in part to fix myself.  A girlfriend broke up with me because I did not have the energy to keep up with her physically.  I got strong, I got in shape and I shredded my leg to pieces.  The skin had peeled off of about 40 percent of my lower left leg between my knee and foot, and off most of my ankle.  The pain was no longer hideable.  I took 2 weeks vacation to heal, but did not get signficantly better.  I worked another month before I was directed by my boss to take medical leave.

At this point I was of the belief that I was going to lose the leg, and that did not frighten me.  At least I would be visibly disabled.  At least no one could look at me in a wheelchair or on crutches and say  "He's just a lazy ass crybaby".  At least I could say I lost my leg being tough.  At least I could say, I am a typical person doing typical things in life and I had the scars to prove it (to myself).

The practitioner that treated me called my recovery a "Christmas Miracle" 10 weeks later.  Unfortunately from being sedentary for 10 weeks, I noticed a familiar stiffness and shortness of breath the day I had the bandages removed for the final time.  They said it was probably just a cold but I should have it checked out.  I was supposed to return to work the next day so I was stressed  It was in fact the beginnings of another pulmonary embolism.  Nowhere near life threatening because I reacted early this time.

This is how the bullies, the abusers, the gaslighters and the haters win.  They don't have to spend their lives abusing you, you will do it to yourself far more efficiently.  The people who taught me how to hate myself are either long gone from my life, or I keep a safe distance from them. 

They don't tell you "You are this is what you are, be proud".  They tell you "You are different....become same or die!".  Even now, I wonder.  Am I autistic, or am I making an excuse for not being same?

Sunday, March 17, 2013

To the two tools making fun of me on Mamaroneck Ave yesterday

   Trigger Warning: Bullying, Strong Language


    Gee I've never heard that one before!  They used to call me lurch in high school.  That was before I went out for football and started lifting weights (funny how a little muscle tone exponentially decreases peoples urge to bully you).  That was before I was aware of how awkward my posture, gait and walk were.

   In the world of gainful employment, I have learned to control my movements in public somewhat,  to be conscious of my back being straight and my feet pointing forward.  However, on the 6th day of a 5 day work week, when I have 4 hours of stuff to get done and 3 hours left to do it, I stop giving 2 shits if someone thinks I move like a .......

   Exhausted, at the end of a break I was rushing to get an extra large coffee, contemplating not my mannerisms, but an espresso shot.  I hear what I have heard a thousand times before.  I know they're talking about me.

   "Derp..dee...derp", "Derp..dee...derp", "Derp..dee...derp"

   I have never seen these two persons before.  Male fantasizing ensues.  I want to kick the ever loving crap out of them.  Or at least confront them.  But I have a job, I don't have a criminal record, and I don't have time.  I open the door to the coffee shop.  Then I promptly close it.  They have 1 worker and the crowd at the counter fills the store.  I would not have fit in the building. I decide to head back and settle on a Red Bull.

   "Awfully crowded in there"  one of them says to me in an infantile tone.  I know when I am being patronized.

   "Yeah".  I reply and start walking back towards work.  Even when dealing with people I don't like, I am programmed to act with a certain level of civility.  I work in retail after all.

    I hear their whispers and giggles as I walk away.  Then a lady I did not recognize (but wish I did, she was quite attractive) called me by name and said hi.

   I responded and asked her how she was, all this time having no idea who she is but being quite happy to see her.  She was about to go into a movie theater and saw me moving quickly, so the small talk was short and sweet.  The way I like it. I noticed that the snickering of the two fools standing on the sidewalk behind me had ceased.  

   And thus ends the cliched feel good story of week of the socially awkward Autistic nerdy guy becoming cool and his bullies being taught a lesson when accepted publically by a pretty woman he can't remember.  (FYI I never dated her.  My face blindness isn't THAT bad).  

  Or not. This shit really pisses me off.  I wasn't joking when I said my first reaction was to clobber these two clowns.  The timely acknowledgement of that woman made me feel relief for a brief second.  This brings back memories upon memories of being teased, bullied and rejected until I decided to stop accepting that.

    I am at least 8 inches taller, and in much better shape than both of them.  I might be slightly younger too.  Also they were smoking, and I doubt late 30 something smokers started smoking last week.  They didn't appear to have spent any intimate time with a bar of soap recently either.  My point being that these two jackasses are not anyone to be mocking me or anyone else, and if they wanted to take it further...well it would hurt them a hell of a lot more than it would hurt me.  

   I did not pulverise or confront these two because I was on work time and it is not worth it.  I cannot fight every battle that comes my way.  I do not have the spoons for it.  No human, autistic or NT does.  I cannot lash out everytime myself or someone like me is mistreated because the fight would never fucking end.


The Forgotten Fire

   Type "New Rochelle" into Google.  A lot of people have been talking about New Rochelle lately.

   There was a ridiculous buzzer beating shot made by the boys basketball team in sectional playoffs.  You may have seen it on SportsCenter and featured on the front page of ESPN last week.  Its all over YouTube too.  The team is still alive in states and has advanced to the semifinals. 

   Super Bowl Champion Ray Rice is also from New Rochelle, New York.  There was a parade held for him here recently.

   Iona, a small college situated on the northern end of the city qualified for its 2nd straight NCAA tournament.  They're hoping they don't blow another 30 point lead in their opening game. 

   There is a lot of small town style civic pride going on in this normally nondescript suburb of New York City.  A city that pushes a population of 100,000.  Middle class homes and apartments to the south, a diverse urban heart that can't really be differentiated from the nearby Bronx and properties with 7 figure values to the North.  Express trains that run every 15 minutes during the day get you into the heart of Manhattan in 20 minutes.  A happy suburban utopia with something for everyone, right?

  Back in January of this year there was a fire at New Rochelle High School.  During the evacuation, two students who use wheelchairs were left on the 3rd floor of the building for at least 20 minutes while the building was evacuated and cleared by emergency responders.  Enraged parents rightfully complained to the Justice Department, and an investigation is under way.

   Reports of this incident "broke" during the fourth week of February.  I use quotations because this story is conveniently shuffled amongst the media celebrations.  I live in this city.  I watch the local channel 12 news often enough and I heard nothing of this.  I asked a few parents of some kids in the school that I know (not exactly a statistically significant survey)if they heard anything about kids in wheelchairs left in the school.  The parents did not know.  One parent called her son and asked him.  He did not know.  My point here is that this story isn't exactly trending.

   Here is a report from local news that came out 2 days before the above posted NBC NY story that is much more sympathetic to the New Rochelle School District.  It states that according to NRHS, the Fire Dept. knew of the location of the disabled children and advised the school to move them to their position, a direct contradiction to what the father of Jennifer Feltenstein told NBC.  Both sources agree that her father objected to her having classes on the 3rd floor, where there is no escape route from the building that does not involve stairs.  An "advocacy" group in Westchester County gave support to NRHS, agreeing that the school was right to follow the (disputed)judgement of the Fire Dept and keep Jennifer put.  (If you have a group of folks that requires civil advocacy because its not being treated as equal in society, and you have a complaint, and you back down from that complaint because an agency of the government of the society oppressing you says "its fine!"'re not a very good advocate)

   I have a lot of issues here.  First and foremost, if it is deemed necessary to evacuate 3000 students from a building from a threat posed by burning wires, how is it that two students in wheelchairs on the highest floor of the building are in less danger and don't need to be removed?  I didn't know there was middle ground in an order to evacuate a building being threatened by fire. 

   Feltenstein's father, Rich tells NBC that the faculty is not trained in using the evacuation wheelchairs.  When I went to school there was a little thing called a fire drill.  They happened several times a year.  Everybody is supposed to do some nifty role playing in a fire drill.  Wouldn't part of making pretend there was a fire and evacuating the building in an orderly fashion also involve getting physically disabled students into evacuation wheelchairs and getting them out of the building as well?  How can they have no experience evacuating students in wheelchairs?

   The concept of "safe rooms" defies all common logic as well.  If the school is on fire what room is safe? ......Really?  safe room?  Did Miss Cleo divine with a tadpole and develop this strategy?

   An aide and a security guard kept Jennifer company on the 3rd floor during the fire.  It must be of great comfort for her to know that should she perish in flames, an aide and security guard will perish with her.  Could the aide and security guard have been.......I don't know.........maybe... maaaaaybe trained in evacuating her?

   Mr. Feltenstein complains about Jennifer having classes on the 3rd floor.  I don't agree with that.  Faculty on the 3rd floor should be trained in evacuating physically disabled students.  She should have access to any class she wants to take in the presence of her able bodied peers.  Only if its a logistical impossibility to remove her from the 3rd floor should she not be up there.  Impossibility, not inconvenience or requiring effort on the part of a professional. 

   This whole situation reeks of deep social ableism.  The "safe room" strategy is after all a NY State mandate.  NRHS taught 3000 students on that day that the lives of the physically disabled are not worth the extra effort and teamwork to get them out of a building.  Media plasters inspirational stories of people running into burning buildings to get their pets and emergency responders rescuing kittens, but we leave humans in fires if its inconvenient to help them move.  When a disabled person loses their life, society will not question its self, it will blame the disability.

   Something for everyone in this suburban utopia.  If you're disabled then that something is silence, or your ass roasting on an open fire. 



Sunday, March 3, 2013

Of Empathy

Trigger Warnings: Aversive therapy, murder, very disturbing imagery in linked source video
   Throughout my self diagnosis journey, I have repeatedly encountered Prof. Simon Baron-Cohen and the Cambridge Autism Research Centre's (ARC)diagnostic tests and studies.  Many Autistics have a great deal of criticism of their work.  I found some of their tests myself to be rather inconclusive, flawed or just flat out bizarre.  Particularly their AQ test and CAM face reading test.

  The first link on their page takes you to a TEDx talk that Prof Baron-Cohen gave to British Parliament that was published on YouTube on 9/12/2012.  Entitled "The Erosion of Empathy" It instantly grabbed my attention.

   Autism is not the primary topic of the presentation, though he does make mention of it.  He discusses his beliefs on the causes of human cruelty and the seeming increase of it in society recently.  To summarize, he argues that the Good vs Evil paradigm is not scientific and therefore not valid.  He presents that human empathy is scientifically quantifiable and can be measured.  He says that social factors, genetic factors, and environmental factors can mitigate human empathy, leading to increased cruelty.

   He breaks down empathy into two components (1:33 of video).

Cognitive Empathy:  The ability to imagine someone elses thoughts and feelings (Theory of Mind)
Affective Empathy:  The drive to respond to Cognitive Empathy with an appropriate response.

   At 2:20 he presents us with his empathy "Bell Curve".  This is where I first started to question this talk.  It is a remarkably clean graph with perfect distribution in relation to empathy and population .  He rates empathy level between 0 and 6.  0 being low empathy and and 6 being high empathy.  The curve perfectly peaks at 3 empathy, where the median and mean both perfectly lie, snuggled together.

   Is empathy a statistic?  How does he rate an individuals empathy between 0 and 6?  With his AQ-10 test?  Why a scale of 0 to 6?  Should Wizards of the Coast include empathy as a rollable stat in the next edition of Advanced Dungeon & Dragons?  My Autistic halfling monk has 14 strength, 15 dexterity, 11 intelligence and 5 empathy.  I hope the DM gives me a +5 empathy enchanted ring so he behaves like a neurotypical in front of the King.  Sound ridiculous?  It should.  Role Playing games are fun, but real life does not even come close to functioning like one.

   At 3:00 the discussion of the "erosion of empathy" begins.  The first mitigating factor Prof Baron-Cohen presents is authority.  He says that an authority figure commanding or reassuring a subordinate tasked with doing something harmful to another human can mitigate the empathy that person feels.

   I find a sad irony in this, since ABA treatments designed to normalize Autistics that are endorsed by leading charities in the US (Autism Speaks) use aversives disturbingly similar to the electric shock example he uses.  Perhaps, since he is a leading global autism researcher, Prof Baron-Cohen can make presentations to these organizations and practitoners explaining to them that they are eroding their own empathy and the empathy of the human race in general with the treatments they use to force normalization on Autistic people that they judge as having little to no empathy.

    I also wonder, did the participants that delivered the shock not experience the empathy?  Or did they disregard it out of fear of the authority and the consequences or disobeying.  Were they not aware that it was morally incorrect to deliver the shock?  I believe that it is an erosion of courage, not an erosion of empathy that lead the participants to deliver the shock.
   He presents the second and third mitigating factors of empathy as Ideology and In Group-Out Group relations.  I believe that these two factors he has seperated are really the same factor.  For his ideology example he uses Al-qaeda and the 9/11 terror attacks and projects that the terrorists believed that their ideology was morally correct, therefore able to carry out their murders with a clean conscious.

   For In-Group-Out Group relations, he tells us of Rwandan ethnic cleansing.  One groups leadership spread propaganda against the minority, equating them as sub-human and therefore able to carry out the cleansing.  Very similar to the Holocaust.

   I say that this is the same factor because an ideology often carries with it the belief that those that don't share the ideology are the enemy and morally perverse.  The ideologists are the "In-Group" and the target is the "Out-Group".  Ideologists often use religious texts as their propaganda to excuse hate and death to the "Out-Group".

  I do agree with Prof. Baron-Cohen here.  Fanatical ideology and media propaganda can and do very much erode human empathy by portraying a group as sub human and morally lacking, suggesting that they are not worthy of empathy, or even worse, teaching that it actually good to kill or marginalize that group.  Empathy towards family and those in the "In-Group" would actually promote the abhorrent acts against the "Out-Group".  The actors operating on the belief that they are saving or defending the superior however endangered "In-Group".

   From 4:34, Prof Baron-Cohen explains the acts of serial killers and presents a comparison of psychopathy to autism.  He returns to the two components of empathy that started the talk.  He says that serial killers possess the "cognitive empathy" to understand, communicate with and seduce victims, but they lack "affective empathy".  They just don't care.  He presents Autistics as a polar opposite, saying that his studies conclude that Autistics lack the cognitive side of empathy, but when an emotion or experience of another is spelled out clearly (he used a piano lid crushing someones fingers as an example), Autistics display an abundance of "affective empathy".

   I am glad to see Prof. Baron-Cohen present to the legislature of one of the world's most powerful democracies that he has scientific proof that Autistics are not prone to kill.  He helps greatly in that regard.

   However his statistical quantification of a human emotion in an attempt to predict and explain behavior, and his labeling of empathy do no favors to Autistics.  Especially the term "cognitive empathy".  It is true that most Autistics do struggle to instinctively perceive non verbal cues.  However is this failure to understand really empathy?  A lack of humanity?  A lack of caring? It is not!  It is a struggle to understand a physical language.  A language that in many cases may never be natural, but can be learned in many cases.

  When an expert such as Prof. Baron-Cohen uses a term such as "cognitive empathy" he does not realize, how by his own theories he is creating real danger for Autistic people in the world.  Those who seek to keep Autistics as the "Out-Group" will make sure the statement "People with autism lack cognitive empathy" will be seen as "People with AUTISM LACK cognitive EMPATHY "in the public conversation.

   It would be positive if we called "affective empathy" what it is, which is simply "empathy", and identified "cognitive empathy" as the ability to recognize the emotional state of others based on non verbal cues.  Society should recognize that the lack of ability to read this language instinctively based on neurotype is not a personal failing, and give support to Autistics to help with that so they can exist in a 99% neurotypical world.   Society should realize that Autistic people do in fact have empathy and care about their fellow man and their communities as much as anyone,  even though those communities don't often care back.

   I think Prof. Baron-Cohen has done a lot of work that in the annals of scientific history will be seen as steps in the correct direction.  However he is trying to wrap all of his findings in a box, and do so now.  There is much more about the human brain and autism to learn than has been learned.  To turn emotional human behavior into a mathematical science with perfect shaped bell curves, graphs and even population distribution with predictable mitigating factors is a long way off, if ever possible.  His talk does not discuss the factors of free will and personal desire at all.
  Finally, do Autistics even lack "cognitive empathy"?  TheAnMish posted this video on her video blog where she discusses her experiences giving and receiving "cognitive empathy" with fellow Autistics on different levels of the spectrum.  She suggests that Autistics experience "cognitive empathy" with each other because they identify each others physical language. 

Saturday, March 2, 2013

Autistic People technicians

  I am a full time pharmacy technician.  I have held this job for 6 years.  I work sometimes up to 50 hours a week.  I interact with a lot of people, sometimes over 100 in a day.  It is not easy to deal with so many people in one day.
  It is not my first retail job.  Most of the jobs I had involved me dealing with the public.  I was not very good at it at first, which is likely why I did not keep those jobs.  I am not terribly comfortable with the public, but I manage.
   Out of desperation, over 10 years ago a friend got me a job at the electronics retailer he worked.  High pressure sales, you produce or get out.  Fortunately, he was a good friend and taught me things.  Fortunately the job had training videos.  I learned the value of small talk and eye contact (or in my case, feigning it).  I don't much like small talk, but it has much value to others.
   With a template on how to sell, which I followed with precision, I became an above average performer.  Nowhere near the best, but not in fear of my position.  I also suffered tremendous anxiety from that job.  I felt like I was forcing people to spend hard earned money on things they do not need.  Why spend money on things you don't need?  It troubled my sense of logic that I was there to convince people that they need things that they don't need.  I was ashamed of myself and I quit.
   The pharmacy is different.  People come in for things they do need, and its my job to help them get it.  I am much more at peace with that, so the socializing does not bother me as much. 
   Many of the skills I learned from the electronics job serve me well as a pharmacy employee.  Most of the people that come in are suffering, or caring for a loved one that is suffering.  Even if it is just for a maintenance drug, that prescription is a reminder to that person of their own mortality.  Eye contact, a soft smile and brief small talk off the topic of illness of medication makes the experience more pleasant for the patient.
   Most people are in a hurry to get out of the pharmacy, which makes the small talk brief and unstressful.  Occasionally you get a person that likes to talk.  My talk template runs dry in about 120 seconds, then I am in trouble.
   Having engaged in social pleasantries makes moments when a patient has a high unexpected copay or deductible or no insurance at all, and not expecting the cost less traumatizing for me,  I do not like to give people bad news, it causes me great stress.  If I am tired, especially at the end of my day I do sometimes forget my social pleasantries.  I look at the counter while I speak and do not make small talk.  This results in whatever problem that patient may have being taken out on me although I am not the cause of that persons discomfort.
   I wish interactions could be more brief.  The sooner I am done, the sooner that person gets to go home and take their medication, and the sooner I can get to work on the next one.  Less suffering for all that ends sooner, but for some reason that perfectly reasonable philosophy is lost on most.
   Social pleasantries help when dealing with call centers for insurance.  I have never worked at a call center, but they say it is an unpleasant job.  The turnover ratio is high.  I have a template for talking to them.  I try to guess where they are from by the accent.  Then I ask them how the weather there is.  Gets them on my side, which is good since they are essentially my enemy and working for a company that is being a jerk and not wanting to give medication that is making my patient feel better or possibly keeping them alive.
   I work in a small pharmacy.  Three people back there at most normally.  Sometimes managers and visitors come.  I don't like them in my workspace one bit.  Sometimes too many patients are in the pharmacy, with too many conversations that I hear all at once.  Sometimes my clothes are too itchy.  Sometimes the sun is too bright through the window.  Sometimes I tell my boss I have to go to the bathroom and I cool down in there.
  I like to touch the door to the storage room.  I keep my water and coffee over by that door on top of a half sized fridge, and it is cut off from view by a shelf of medicine.  People think I am going for a drink, but I am going to touch the door.  The door is cool and smooth and I like it.  I wiggle my toes inside of my work boots while I count pills.  I shift weight from one leg to the other while at the cash register.
   The store has had the same song list playing over the speakers for years.  I like to sing along until I am told to stop, which is often.  It has been brought to my attention that I cannot sing.  I don't dare dance....I have the grace of a groggy hippo.
   Sometimes patients die.  I have to go to the bathroom when I hear about it and hide.  Sometimes I cry,.  I do not let people see me cry, at home or at work.  Sometimes a friend or spouse of that person comes in to the store.  I don't know what to say.  I say "I'm sorry".  I wish I had something more profound to say but my mind does not give me words at those moments.
   I like what I do, I like to help people.  If I feel like I helped someone it makes the discomfort worth it.  Also dealing with the suffering keeps my own life in perspective..  People at work like me.  They know I am a weirdo but its ok.  We are all human..