2) Medication Reconciliation Sheets.

#2. The Med Rec Sheet.

Medication reconciliation is another one of the many things that make pharmacists irate. Perhaps a bit of background is required.

Sometime back a long time ago (I'm not really sure when...before my time, anyway) someone in academia and Joint Commission decided it would be a great idea to have a prepared document that was able to be generated listing a patient's medications they take at home and the list of medications they are taking while in the hospital. With this list, practitioners would then decide whether or not each med would be ordered, continued, discontinued, whatever. And if a patient is on, say, two statins, the physician can note this and tell them they only have to take one of them. A sheet is thus filled out upon admission, transfer, discharge, etc.

Now while I admit that this all sounds rosy...and it's probably needed... it unfortunately gets executed in a way that causes the average hospital pharmacist to want to just end it all and jump into the nearest volcano.

In fact, personally, if I were given the choice between dealing with a med rec sheet and stabbing myself in the eye with 25 years worth of Rossanne Barr's blood red tampon drippings frozen into the shape of a giant 25 foot tall, razor-sharp icicle...I'd make sure my vision insurance is up to date and stab away.

So where do I start.

Well, it should be understood that every initiative that is started and, later, required in hospital pharmacy practice is started by people in academic teaching hospitals. As such, all initiatives are designed and created with these types of facilities in mind. So, in these humongous hospitals, they employ 50 bazillion pharmacists. And, as such, one or two of them are freed up to go around and compile medications to be placed on med rec sheets, analyze them, and THEN give them to a physician for review. I'm sure the whole thing works dandy in this setting. Keep that all in mind.

Now that I think about it...this is a pointless tangent, children...whenever I was on rotation at the hospital that was attached to the school I graduated from...I'd see dozens and dozens of pharmacists every day...but I swear to God, I never saw any of them doing any actual....work. The IV pharmacist is the only exception I can think of. In fact, the ED pharmacist I hung out with just stood around the ED all day doing nothing, then went up to the surgery satelite he was also responsible for and played on the internet for a few hours.

Yeah...

Anyway...in the real world, there aren't that many damned pharmacists laying around.

Let's take my institution for example.

I typically work afternoon shifts from 1-11 (mostly because I still sleep until 11:30 most days...) As such, and being that I work in a locale where something like 80% of the people are on Medicaid, there are only 7 full time day/afternoon pharmacists for a hospital with a census of 150-200. That's all we can afford.

That means that I am there, alone, between the hours of 5:30-9PM. Not to mention that our hospital can't afford to give their employees a typical prescription insurance card that can be used at an actual retail pharmacy...so we actually have to dispense prescriptions for every hospital employee, too...which is total balls.

So, yeah, one dude, alone, with 150 patients and a mini-CVS on the side. So that one pharmacist is dealing with the mountains of post-op admission orders (which, yes, have med recs of their own) and regular admissions that the first shift nurses were too damn lazy to send down during their shift, so they punted it to second shift...which starts at about 4:30.

All of this together means that there is no way in hell I'm going to be able to go down, interview a patient, and compile an accurate med rec sheet.

So, in these non-utopian hospitals...who does the compiling of info for med rec sheets? And it's the damnedest thing...I actually had no clue. In fact, none of the pharmacists did. So I looked into it one day when it was slow. Turns out that it's rather random based upon which floor it is. But USUALLY, it's a nursing aide. And that should frighten you.

Personally, this doesn't surprise me at all. It explains why I get orders for drugs such as "Zopenex 0.31mg" and "hydracompatyazime 25mg". And they'll write down any stupid ass thing the patient tells them, too.

I swear to God this is true...one time we got a med rec sheet that had "Cannabis" listed as a home med. (the physician ordered it because he was a "liner"...I'll get to "liners" here in a bit...) The pharmacist on duty called the physician to "clarify"...of course putting the phone on speaker so we could all hear the mass hilarity...our buyer offered to drive up to Homewood (Pittsburgh ghetto) to try to get some if Cardinal was out of stock.

I few weeks ago I had one that listed "whiskey" as a home med.

I swear to God this is real.


Now one might think...well...that's no big deal...right? I mean the physician checks them and knows what's wrong....right? ....uh...right...?

Ha. Haha...hahahahaha. No.

As I've discovered, either way too many physicians know jack about drugs or way too many are too lazy to actually read the things. So what happens is that they will order drugs that are jotted down wrong. Then we get it. We notice that it's wrong...however...yippee...we don't have prescriptive authority...so that means we get to CLARIFY all of this shit.

Say some crazy patient tells the clerk that they take "Phoslo 125mg one cap TIDAC" (this happened yesterday). The physician orders it. Well, sumbitch, it only comes in one strength, 667mg. So that means we have to clarify it. If we just put it in for 667mg TIDAC, an idiot nurse that thinks they are more of a drug expert than a pharmacist will call you and threaten to write you up because you are trying to overdose a patient with 5 times the ordered dose. Not to mention the patient's calcium is like 13 and they suffer from renal failure, so they shouldn't be taking it, anyway.

So to avoid this, we call the ordering physician and do the song and dance of "clarifying" the med rec sheet. Usually this means we tell them what it should be and they agree with us.

Sometimes we get physicians that are privy to the whole stupid ass system and humor us to the "importance" of our phone call. We know it's stupid, they know it's stupid, but we just get it over with and that's that. I can deal with those people.

But there are "those."

The ones that actually know what Phoslo is will scold you for wasting their time as Phoslo only comes in one strength. No, they don't care about JCAHO regs. They care that their golf game was interrupted. They will call you an idiot, tell you "Yes, MORON, make it 667mg"...and then you hear the words "stupid f'ing pharmacists" faintly in the distance...right before you hear the click of them hanging up on you.

Then you have the ones that have no idea what the hell Phoslo does, they just ordered it because it was one of the options on the home med list. You'll tell them "Well, not only is the dose wrong, but the Ca/Phos product is above 55...which has been shown to increase risk of mortality in these patients. After about a 5 second pause, they'll just say.."Uh...yeah...let's cut that one and I'll consult Renal about that." Of course, I could tell them that Renagel is a great alternative, but being given advice from a pharmacist is like a 15 year old kid getting scored on by a 3rd grader in a game of neighboorhood pickup ball to these people. So they kinda avoid it at all costs. Plus, they play golf with the nephrologists, so consulting them gives their friends a reason to bill the insurance companies.

Then we have my most hated brand of med rec sheets. The ones filled out by the "liners".

So what, pretail, is a "liner?"

A liner is when a physician is too damned lazy to actually read their med rec sheets and they just draw a giant ass line down the "Order" column of the sheet. They get away with this because they know that the pharmacist will have to make sure everything is kosher...plus the nurses wait until 4:30 to fax down new admits as they don't want to deal with them on their shift...and by then, they are already long gone and some random hospitalist has already taken over call for that patient.

"Of course I read it. Honest." A classic example of a "Liner." Due to the lack of a defined insulin sliding scale for the above patient, we had to call the physician on call to get it corrected. Not to mention the fact that Vicodin doesn't come in 7/750 (that's 7.5/750). The dude that wrote the order slipped out right after signing off on the order. It probably wasn't a coincidence.

So anyway....to put this into perspective. About 10-70% of med rec sheets have issues that need to be corrected depending on what day it is and who's in the ED/OR/whatever.

At 5PM when the nurses from first shift fax all of the new admissions they've gotten since 1PM, then run out of there as fast as they can upon hitting the "send" button...and like 30 of them do that at the same time...which means I get a stack of like 20 admissions and med rec sheets. And they start coming over and collecting at about the same time the army of first shift pharmacists start to leave...

...and of these, like 5 are wrong.

2 are so f'd up that I have to call the pharmacy to figure out what the hell that patient takes.

Meanwhile, there is a nurse that's addicted to Vicodin at the door demanding her bi-weekly candy.

I have three nurses on hold demanding meds that found their way to the mysterious black hole...

Then I find out that the patient's pharmacy is Caremark mail order (God help me)...next thing I know, I'm sitting on hold with Caremark on speaker phone, talking to a nurse about why her Phoslo 125mg hasn't been sent up to the floor yet on another phone, checking a script for Vicodin my tech so kindly typed in and filled for me...then another nurse shows up at the window wanting to know why she can't get through to the pharmacist because both lines are tied up and she needs her now dose of Maalox...

...all at the same time...

...and it all piles up there because the entire implementation and existence of med rec sheets in the typical community hospital is so poorly executed...and so relentlessly dumped onto the the laps of helpless pharmacist...that it makes all of us so damned irate. And there is no way to make it any better because, again, in the real world...there are restrictions on manpower...

And I'm not even going to go into the situations where a physician discontinues a medication on the "current medications" sheet (which is one section of the med rec sheet), then reorders the same damned drug with the same damned direction on the home med list (the other part of the med rec sheet). Does he want it...is he just testing us to see what we'd do? How the hell should we know.

But when I get in a med rec-caused situation that stymies me from accomplishing anything...yeah...sometimes I curse...sometimes I throw things...sometimes I bang my head against the wall...and sometimes I just cry.

But at the same time, at least it shows me how needed we apparently are. Because if we weren't there, I'm pretty sure that an only moderately-opiate tolerant patient would die from taking 300mg of OxyIR (like I had one med rec say...those pesky extra digits...) And saying that we legitimately save patients from harm can seriously be drawn just off of the strength of the organizational abortions that are med recs alone. Job security...right? At least that's what we tell ourselves.

And that's why med rec sheets are one of the things that make hospital pharmacists irate.

1) The Mysterious Black Hole

1) The mysterious black hole.
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Yes. The mysterious black hole.

Ask any hospital staff pharmacist and he/she will know what you are talking about.

By my estimation, there is a realm of existence somewhere in the unknown universe where millions, possibly billions, of unit dose medications are floating around in the vacuum of space - lost in time from all of humanity for the rest of eternity. Perhaps we have allowed Marvin the Martian to come to discover Viagra.

Marvin after visiting the mysterious black hole.

So what the hell am I talking about?

There is this bizarre phenomenon that is observable at every hospital I've ever been to...and it seems to be an issue everywhere.

Pharmaceutical products, while in the institutional setting, have the physical chemical property of vanishing from the face of Earth. And not just the pharmaceutical itself, but the packaging, labeling, and every physical record of its existence.

Case in point, every day pharmacies compound IVs. Say a physician wants to be a dick and order a bag of IV fluids that aren't commercially available as a precompounded bag. Say, D5 1/3 NSS w/ 30 of KCL. Then say it's 8PM. You are the only pharmacist around and you're one technician is about to go on a round. You have the tech make it and it goes with her on the round. Now the ODDS of that bag of fluid finding its way to the mysterious, evil black hole are roughly 40%. You will sign off on the bag. The tech will put the bag on her cart. The cart will leave. 15 minutes later, a nurse will call you. They will claim your tech has been by and the IV isn't there. So what happened to it? The mysterious evil black hole got it. It happens that fast. So you have to personally go back and make another one while the tech is gone because you don't want the patient with a K+ of 2.8 to suffer. Of course when the tech comes back, she SWEARS she put it in the med drop-off box. You have no reason to doubt her. Just in case, you send her up to investigate the med room. Sure enough, it's not there. And that solves it. The black hole strikes again





Artist's rendering of The Mysterious Black Hole. circa 2009. Note the high percentage of items that are expensive or take some time to compound. According to Mike's First Postulate, 1 minus the product of 100 divided by the cost of a product in dollars times the number of minutes it took to make said product is the probability of that product disappering into the mysterious black hole. Take the TPN for example. 1-(100/[$99 + 35 minutes]) ~ to a 25% it will go missing. Any drug with a probability of less than 0 can be assumed to not have this property. Mostly because nobody cares enough about them to become irate if they go missing.


However, the most...well...mysterious property of the mysterious black hole is that the status of each item appears to be transient in nature. They have the tendency to magically reappear the next morning when the techs go around to round up the unused meds from the night before. Where did it go, how did it get there, why did it go there...nobody knows...but there it is. Back from it's mystical and wonderful journey to the center of somewhere...back to the exact same spot it was put 14 hours ago.

Some may say, "But Mike, perhaps they were just misplaced." Bullshit. There is no way in hell a person can misplace a gigantic-ass TPN the size of a small table. It's an unfathomable thing to happen. And we all know that nurses are bright people that never make errors and have IQs well above 140.

Another interesting phenomenon are the types of drugs that never seem to magically reappear from the mysterious black hole. These usually include drugs that are remedies for common ailments. For instance, I usually observe a 5-count sleve of azithromycin missing from the Pyxis. Or perhaps a patient's Advair discus went missing before it ever got used once. Or perhaps a Lantus pen went missing.

Some may say, "But Mike, those items were probably just embezzled by nurses that are too cheap to get a script for a Zpak or are too cheap to actually be expected to buy their own maintenance medications." Ha, fools. Clearly the martians that live near the mysterious black hole are using them. It is perfectly reasonable that they have bacterial infections or suffer from asthma. We all know that nurses are the most trusted profession on Earth. The Gallup Poll says so. They would never, ever lie about where the meds went or, *gasp* steal them. Sure, nobody would ever find out, the pharmacy never keeps track of which meds go missing, and the temptation to take them is gigantic...but they are NURSES. They would never, ever do anything wrong. Ever.

The mysterious black hole. One of the things that make hospital pharmacists irate.

My Car Exploded. No....seriously. *Boom*

So I haven't posted in months. I suppose one or more "clever" person(s) has noticed how fitting that is to my blog name.

Anyway....MY FREAKIN CAR EXPLODED!

So I'm at Sam's buying bulk Mike-sustaining supplies. This includes bulk chimichanga packages, bulk pot sticker packages, 30-packs of bottled water, bulk packages of Kashi Go-Bars, and #90 Adderall 20mg....which is kind of like a bulk purchase.

So anyway, I'm checking out and a few dozen employees start running in and out of the store in a panic. Over the intercom they announce, "if you are parked in the side parking lot, you need to move your vehicle....NOW!"

Being that I was parked in said lot, I kinda put a little bounce in my step and "rode" the back of the cart to the door where the old receipt checking guy was doing his incredibly easy and pointless job.


As he's magic markering my receipt he says to some other employee, "Hey, Bob, will you tell the owner of a Red Buick in the side lot to come to the parking lot IMMEDIATELY."

Odd, I thought....I was driving a red Buick.
So I continue using the shopping buggy as a scooter and scoot myself to the parking lot where....you guessed it...my worthless deathtrap of a Buick was engulfed in flames and a dozen or so Sam's monkeys were dancing around my car with fire extinguishers. It was like trying to extinguish Dante's Inferno with a squirt gun.
And not a cool super soaker

....oh no. One of those dinky plastic jobs you buy at Kroger for 85 cents in the checkout isle.....
.

In time they realized that their futile attempts at making my car less on fire were...well...futile. Eventually the fire department shows up. For some reason they decided the best course of action was to beat my car with a giant ice pick looking thing (no, seriously). After realizing that you can't beat a fire to death, they whipped out the water hoses and finally took the fire out. By this point, I swear to God, no less than 400 people were standing in a circle around the car. I almost expected a guy with a hotdog on a stick to show up in a few seconds all pissed off that they extinguished his barbecue. You'd be amazed at the amount of smoke a 1998 Buick Regal LS can produce.

Then this idiot old guy notices all of the parking spaces available and actually parked his car three spaces away from my charred hunk of metal with a dozen firemen running around it, blasting it with water. He gets out all proud of his space, then while walking to the enterance, glances right and *realizes* in a sort of shock the commotion that has magically appeared in front of him. He then gets in his car and moves it away. It was damn hilarious.

So afterwards, when it's out, I approach the car. A firemen goes, "I'd hate to be the poor son of a bitch that owns this piece of ****!" as I'm standing two inches behind him. I pat him on the back and say, " 'at's me, buddy." The look on his face was priceless. I think he may have actually thought I was mad at him.

I tried to talk to them about the entire process of why a car decides to spontaneously explode. Their best answer was, "It's been happening a lot around here lately. This is the fourth one in two weeks. It just seems to happen." I asked to see the security tape, but for some reason the Walton's only pay for "lookin'" cameras, not "recordin" cameras as a Sam's employee so eloquently pointed out. Being as though I only had liability on that piece of crap, I'm up ****'s creek without a mechanism for fighting it's current. I'm personally hoping more cars explode and some ******* arsonist is lighting them up. Then I might get some cash from someone.

That won't happen though. I'm sure my car randomly exploded. It's so absurd and ridiculous that it is just one of those things that *would* happen to me.

Here are some cell phone pictures I took:



I guess I have to get a job now. My evil plan of waiting as long as humanly possible thanks to diligent budgeting has been royally f'd over. Oh well. Maybe it's the universe's way of telling me to stop doing nothing with my life. A nice exploding car....that's one hell of a way to get a point across....

Oh, yeah, the last few months of my life....uh...I graduated finally...I should probably take the Naplex eventually...

Rotation X: Acute Care II.....the post that goes nowhere....

So rotation number ten was in Uniontown, PA....a medium sized town roughly 40 minutes from Pittsburgh....and 40 minutes from Mo'town. It was much more like Pittsburgh than WV culturally. The first day I'm there this pharmacist walks by us around lunch and goes, "Jeet jet? Some good pizza dahn'n the cafeteria, n'at." Haha. They speak Yinzer. The Pittsburgh accent is absolutely confounding to outsiders. It's barely English. I was with two other students and the one from around Beckley (Southern West Virginia) asked me what the hell that person just said. I told her he just wanted to tell us they make good pizza down in the cafeteria....she says back to me, "Nah, he said something about an airplane....I think." Good times.

The rotation was made easy because I was with a person whose love for clinical pharmacy matched my love for pharmacology/medicinal chemistry. Between the two of us, there literally was about 3 things all month the preceptor asked we couldn't come up with the answer to off the top of our heads. I'm pretty sure we left her with an incredible impression of WVU students. The words, "Wow, most students don't know that" came out of her many times during the month. I suppose that should be expected......she tells me she usually gets mostly Pitt students .

I also missed an entire week of the rotation because my lungs hate me. I feel bad for the poor dermatology (I think resident) guy that saw me in student health when I came in. He was so lost. I presented with a history of asthma , afebrile lung infection x 3 days, and marked SOB. His first idea was to give me Biaxin and send me off. Uh, no. The correct answer is give me a nebulizer treatment and some damned steroids. I spoke up and asked for steroids...he went and got the attending family medicine doc...she agreed with me. 20 minutes later I'm breathing a-ok and I got a script for sweet, sweet prednisone.

I don't know what it is, but the vapor from nebulizer treatments tastes really good. I know I'm probably crazy on that one. Actually, I think it's a remnant from my childhood. Remember when the fire department would come around to your elementary school and stick your class in that playhouse thing and pump in that fake smoke....then you had to get on your hands and knees and crawl out. The nebulizer tasted like that shit. Mmmmm.

Due to said steroids, I opted to get some greasy-ass food to defray potential "stomach ouchies". Yes, that's the technical term. I figured I'd get some fast food for the first time in ages. Like as in high school. I was disappointed in my $3 worth of food prepared in 35 seconds by a guy making $5.15/hour. WTF has happened to Wendy's? Their shit used to be delicious. Now the fries taste like cardboard and the best part of their hamburgers are the buns. Jesus. My phlegm was saltier and less soggy than their fries. I think that when Dave died, his company died with him. I miss that son of a bitch. His warm, portley smile on those damned commercials made me feel happy. Just like the guy that pimps those delivery diabetes testing supplies who used to be on the Quaker Oats commercials. I swear to God, every time he's on one of those diabetes commercials, I get this urge for some damned oatmeal. God damn Quakers and their subliminal mind games.

What the hell else do I miss?

Hmm......that Supermarket Sweep gameshow. Shit was hilarious.....and robot dancing. That shit needs to make a comeback. When was the last time WVU has a good mass riot/couch fire? 2005 after the Elite 8 in basketball? That's bullshit. That's the one thing I miss I can actually change. Fuck it, I'm going to go light something on fire right now.

Rotation IX: Acute Care with Omniscience Personified.

So I really didn't know too much about this specific professor, Dr. P. The only thing I know about him is that he is very adamant his students know that when you have a cold, you burn roughly 7 calories per sneeze.

It turns out that he knows everything.

No, seriously, like, everything. It's creepy. Other faculty members I've been around, I really don't sense anything remotely close to omniscient....this guy, no, he actually may have memorized the entire contents of PubMed.

I was at first clued in on his stature as a clinical pharmacist when he was nominated to sit on the Pharmacy academy on the National Academies of Practice during the first week of my rotation. If you don't know what that is, it's kind of a big deal. Any time you are going to be added to a list of 28 or so elite people and the name Koda-Kimble is on the list, well, in pharmacy, you are hot shit.

So anyway, I got to work with this dude for a month. Suffice it to say, I am and remain blown away with the sheer amount of crap that he knows. He raises the bar too damn high. I can't ever even theoretically strive to one day become as good of a clinical pharmacist as this dude. It's not a good idea to put people who have only done this stuff for a few years with this dude. It's like me trying to learn basketball from Michael Jordan. Sure, watching him dunk is cool, but it won't help my slow, white ass...it just makes me feel useless.

Anyway, the rotation went well. I got to see first hand how little medical students know about drugs...again. I asked them about it. Turns out they only get 6 weeks of the stuff total in school. Yikes. From what I've seen, medical training seems to be more like a series of apprenticeships rather than actual school. They just learn about the drugs on rotations as they need to. Whereas pharmacy school is just a series of useless classes that involve things like memorizing telephone numbers of the local poison control centers and knowing what the transtheoretical theory of change is (My WVU peeps know what I'm talking about...)

Back on track...

Patient care is an interesting thing with me. Personally, I hate following patients and using guidelines to solve problems. It's just boring. Really boring. I guess I did a good enough of a job, they never threw back one of my recommendations as incredibly stupid or not the best course of action. If you use chemical classifications to describe drugs, it will confuse the common med rotatee like you wouldn't believe. Calling an ED drug a phosphodiesterase-5 inhibitor will make them step back, pull out a PDA, look it up, then come back pretending like they knew what you were talking about the entire time. It actually quite humorous to watch.

My evaluation took the a slight deviation from normal. I was mildly chastised for not working hard enough and not caring...but with this guy, he realized I belong in Industry or in a lab somewhere and didn't hold it against me. He actually took over an hour to completely evaluate me...20 minutes of which was to try to convince me to go to graduate school and "use my talents." Eh...that's another 6 years. I'm thinking no. Especially because they hire PharmDs in industry, anyway. Why get another degree if my current degree should get me where I need to go?

Oh....and he also said I talk too fast and look like I'm about to fall asleep far too much. Par for the course.

According to the Princeton Review - It's official - West Virginia U is, again, the #1 party school in the nation.

I'm like a damn prophet.

Last year WVU was underrated at #3 behind U Texas at Austin and Penn State at College Park. They clearly did not research that properly at all. I mean, C'mon, we set damned couches on fire after sporting events and Morgantown accounts for roughly 1% of all alcohol sales in the US (at least that's the rumor...) UT and PSU can't carry our beer bongs, let alone challenge us for the throne. I've been in both. They are both weak. Well, relatively weak, anyway.

To the press write up:
----------------------------
MORGANTOWN, W.Va. (AP) — For the first time in 10 years, West Virginia University is back where students say it belongs, ranking as the nation's No. 1 party school in the annual survey by The Princeton Review.

To the historic disappointment of school administrators who have worked hard to curb underage drinking and other rowdy behavior, WVU has been among the top 20 party schools seven times in the 15 years students across the nation have been surveyed.

Not since 1997, however, have the Mountaineers taken the top spot. Last year, WVU was No. 3, bested by the University of Texas at Austin and Penn State — both of which remain in the top 10 this year.

WVU also ranks No. 1 in the category of Their Students (Almost) Never Study.

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To everybody that contributed, good job!

Holy crap...E.S. Posthumus is releasing another album!

For the longest time I thought that the Brothers Vonlichten of ES Posthumus wouldn't make another album because their unbelievably brilliant music (like, the best shit put out by anybody in the entire US right now brilliant) didn't seem to catch on with the mainstream (not that it surprised me or anything...music without English lyrics backed by movements and intricate instrumentation is usually...well...a death sentence...)

....and paying all of the people to play cello, violin, and the rest of the ungodly huge assortment of instruments they use probably wouldn't be worth whoever pays for production of their album to make another one.

But, alas, it appears that they have been going hog wild in the background making more music. This appeared on their website:

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According to ancient legend, the tiny island of Numa was completely destroyed by natural disaster in the Southern Indian Ocean. Its inhabitants had been highly civilized and advanced seafarers. They traded with peoples from every corner of the Earth and developed a language that incorporated all known tongues from that era.

On our next release, "Cartographer", we imagine what this language sounded like and combine it with compositions that are uniquely those of ES Posthumus.

"Cartographer"
ES Posthumus
featuring Luna Sans
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Fuckin' eh! The little music sample they gave on the site sounded like an evolved version of an earlier song they did named "Nara" (known to the casual person as "The Theme Song to CBS' Cold Case) That shit makes my damn month. I have no idea when it's coming out, but apparently the gears are a' turning.

I'm pumped. I thought that I'd never hear this type of music ever again. Thank Jebus!