I use my desktop, and it stays messy.
The left monitor is World of Warcraft. Even if I'm not at the computer, chances are WoW is open on that monitor and I'm AFK in town. I run it windows with the maximized option on so I can alt-tab to Opera or whatever without delay. On the desktop, hidden behind WoW is a bunch of game shortcuts and music videos.
The right monitor is everything else. Opera is open at full screen on it 90% of the time, and the start bar is at the top double thick for lots of taskbar room. On the desktop is about 10 text files with various WoW junk. (materials lists for grinding professions up, list of gear on an alt for my future blood elf paladin, stats on my rogue at various levels from 60-70 on beta.
Quick Launch:
World of Warcraft
World of Warcraft TBC beta
Warcraft Model Viewer
Ventrilo
AIM
Winamp
Opera
Start:
My Music
My documents
My Downloads
I almost never go down to "All Programs", and when I do it's multiple columns wide. I'd clean it up or change it to scrolling, but I never use it, so I don't really care. I find that when running a game on my PC constantly, shit slows down (especially on a PC that's starting to get pretty old) I hate waiting for the taskbar to lag-load, or the start menu, or the programs list, etc. I could probably use a reformat and whatnot, but last time I did that the problem came back within a day or two, because I was still running WoW + other shit at the same time.
What I need is a new PC. I can play games on it, and do IM, web, vent, etc on the old one, So it's not bogged down by the game.
But yea, somehow I went from how everything's organized in a manner that I can get to it fast while WoW is running, to bitching about my PC running like ass.