From Hollywood, it's time now for Johnny dollar dollar my name is strewl strewl bail bond and insurance agency State federal immigration all forms of shorty bonds and insurance. Oh, yeah. Well, I'm sorry. I don't need me No, no, no, that's not the point. I need you to the tune of saving me $50,000. How does that work? I made bond for two men that was subpoena for a federal investigation. They skipped out and I've got to find Who's mixed up in this investigation? The name of Jack Madigan is the big shot, you know him. I've read about him enough to advise you to give up If he doesn't want him found the chances are they won't be alive anyway Oh, no, no, it's not as bad as that look. I came all the way from New York. This is worth a lot to me Can't I talk to you about it? All right, come up to my apartment. Maybe we can work out a deal Edmond O'Brien in a transcribed adventure of the man with the action-packed expense account America's fabulous freelance investigator yours truly Johnny dollar Expense accounts submitted by special investigator Johnny dollar Hartford, Connecticut to the strewl bail bond and insurance agency in New York City The following is an accounting of expenditures during my investigation of the Jack Madigan matter Expense account item one two fifty phoned in New York for purposes of checking your reputation I learned that you mr. Strewl were by no means above reproach But decided that if a federal court trusted your agency I would at least hear you out when you arrived, but you did at once the end Come on in mr. Strewl. Thank you. Thanks for spending me your time I'm in a mess sit down You should have known better than to make bond for anybody that was going to testify against jack madigan There was nothing I could do about it. Who forced you into it madigan I've done business with some of his friends before so he came to me this time and said will I do it The way he said it there was nothing else I could do madigan stood the expense himself Sure, he wanted them where he could get his hands on them and it looks like he did or they took a run out They didn't have to accept bond they could have stayed in protective custody if they were afraid of them They had to if madigan told them to the point is they're gone Unless I can prove they're dead or find them before they're doing court I forfeit the $50,000 25,000 a piece. I've got to do something Why'd you come to me? I told you I've got to do something. It's a federal problem You operate in new york and new york has plenty of hungry private detectives I hear and a fair-sized herd of policemen I'll tell you why I came to you the new york cops are busy enough and besides To them these witnesses are just two names on a long list of missing persons And as for private dicks, I could never be sure that one wouldn't want to make a deal with madigan and make more money Not finding them and I'd be paying to find them. You get the point What makes you think you can trust me? Well, you were mentioned by a fella from one of the insurance companies I sell for They tell me you're straight except for padding your expense account here and there Oh, that's slander. Who told you that? Don't make any difference. What's a little padding? I want to hire you Okay, mr. Struel. You hired me great Now Who are these missing witnesses a nippy bruno is one real names joe the other is max kraus I've got their addresses next to kin what they look like and so on Yeah, I got it all in the sun to look here. Okay Oh, there's one other thing I want to retain it 2,500 bucks What's that for to pay they're going to work for a man. I don't quite trust About 2,500 bucks. That's pretty steep. You don't have to pay it up to you. Yes, but Well, I can't get it to the moral. That'll be fine a cashier's check When I get it, I'll see what I can do for you I didn't expect the check to arrive but it did special messenger the next afternoon Expense account item two twelve dollars and fifty cents transportation from harford to new york city Expense account item three twenty three dollars and eighty five cents dinner and drinks for a herald american reporter Who was more familiar with jack madigan than I His statement enclosed a lot of things have been written and said about madigan by a lot of people including me None of us really know anything about him how much power he has where he got it What his private life is if any These witnesses being missing isn't even news people who've gotten his whip and dropping out of sight for years kim schwarz and big tom green His woody south is just the name of few I'd keep that in mind if I were you Expense account item four one eighty cab fare That same address to an address on 79th the apartment of nippy bruno's next of kin a sister stage name Vivian brown Miss vivian brown in My name is dolla She doesn't know me tell her I have some news about her brother. Come in, please this way, please Miss brown is dressing to go out I'll ask if she'll see you Mr. Dollar is here to see you Who? He says he has news about your brother Tell him to wait I'll get a robot Shall I take your hat? Thanks Please sit down. Miss brown will be right out. What was your name? I didn't get it dollar johnny dollar What makes you think I'd be interested in any news about brother nippy? Well the mention of him got me in here My butler doesn't slam the door on anybody until I tell him to What brought you here? I'm looking for your brother Then you've definitely come to the wrong place Why should you be looking for him? I'm being paid to The man who put up $25,000 bond for him wants to know where he is I don't get it. What bond you don't wear innocence very well angel, but I'll go along with the gag It's no gag and I can do without your info your brother's doing court in two weeks to help the federal men investigate jack madigan He seems to have dropped out of sight. Do you know where he is? No I haven't seen much of him in the past few years. He doesn't approve of me and I don't approve of him Does that answer your question? It brings another one to mind He seemed to think enough of you to use your name on his bond request papers. How about that? All right peeper. I was only trying to do it easy for you red. I heard it You walked into something peeper. I usually do but I'm glad to see you in character That automatic makes more sense than that phony butler act is stand up Better see if he's carrying anything Vivian Okay You're a good boy now until you try to palm my wallet. I will it's all right He's safe. You can sit down dolly Well, but now He should be here in 20 minutes I'll go back to my room. Sure. Go ahead. What's the rough stuff red? It hasn't been rough But if you don't know how close you came to getting your head blown off wasn't this door It's liable to happen to the next one that does Light yourself a smoke Forget about 20 minutes to wait So we waited 20 minutes Vivian came back into the room in a low-cut number that was a good choice for a sullen brunette attractiveness It made her look softer But the few remarks she passed weren't only icy They could have come from a long shoreline I was waiting for a brother to come in that would have made sense What did come in made none at all It was jack madigan Hi jack Come on in and see what found me What do you know about this? How are you jack? Fine. Thanks. What are you doing with that pistol? We wanted to play it safe.  He was hired by that stool to find nippy Why that's interesting isn't it? What do you have to say for yourself my boy matter of fact i'm speechless madigan How's that? I thought I'd have to find you. I didn't expect you to find me yet at least and and here What's so strange about that you and the sister of the missing witness Maybe not so strange at that you got up Keep your remarks to yourself.  He's been needling me for half an hour I'll take her across my knee waving that gun on your face. What for? Anybody knows you can't fire a gun in these apartment houses without causing a ruckus Uh, what's your name? Dala And many strew hired you to find nippy and the other man kraus I'll tell you what to do You go back to strew and tell him the boys are all right Oh, let's not be childish shall we and what river are they all right now see here? There's no need to take such a pessimistic view I realize the press has given me a reputation for violence, but I don't deserve There's no reason for me to want to harm those boys. I'm not afraid of their testimony. I'm counting on And straight testimony no perjury this time Why I've already talked to those federal men I'm cleaning the slate this time telling everything and let the chips fall where they may what kind of stuff is this the truth I'm tired. I've been at sword's point with the police and my government long enough I've been offered certain little leniency and I'm going to accept It's been later than I thought for a long time.  I can't tell you that I've got them undercover for their own good Now dollar don't go off half cocked a lot of heads are going to fall after the three of us who've finished this federal Catechism if you think you're the only one looking for them, you must be a stranger in town You're trailing the pack I don't know if this is all I get from me. I've heard enough you'll drop it And I don't find them before you're doing court. I will What do you want son money? I got some thanks I don't like to hear that I suppose it takes a lot of guts to be a hero, but it sure doesn't take much brain Remember that I can leave Of course you can leave Because I think you're going to talk this over with yourself and come up with an important decision I did talk it over with myself, but not until I found a cab stand on the corner and turned around A quarter of a block behind me. I could make out the figure of rate the so-called butler Expensive count item five twenty dollars fair and tip to a driver who saw to it that our cab wasn't followed When I felt reasonably safe I gave him the address of the second missing man max krauss I didn't know what I expected to find there other than an empty flat with possibly a lead of some kind There was a trace of light showing under the door Money and dollar red I didn't expect a butler in a place like this. Come on in Why didn't you use your head jack gave you a chance to maybe I should have What are you doing here?  I'm max krauss And now I've got to do something about you. Can you prove that you're max krauss? Why should I have to prove it? Go ahead.  American wants you put away until after the investigation Come on back doors closer You can tell madigan for me that this isn't gonna work If I drop out of sight for two weeks somebody's gonna get on the trail it leaves right back to madigan This way I got a car in a garage down the street Let's him get down Let me see Sure Now you believe him. Let me get your coat. Get out of way Hey Turn to the second act of yours truly johnny dollar in just a moment Once a year the community chest comes knocking at your door seeking your help Giving to this worthy cause eliminates many separate appeals Which would be more costly in money time and effort So when you give make sure you give enough to cover the many campaigns the community chest includes give generously Give today Now with our star edmund o'brien. We return you to the second act of yours truly johnny dollar When the windows and the buildings around me started slamming open I left the scene of the killing And carried with me a whole new set of thoughts on the jack madigan matter None of them were good But the worst was the fact that the description I'd gotten of max krauss But in no way fit the dead man. I now the thought was max krauss Expensive count item six care fair to your address mr. strew It's 11 o'clock night, mr.  Who paid you to hire me? What did you say who did paid me to hire you? What kind of a question is that answer it? Well, nobody did it was my investment. Who would protect it but me? What's the matter with you? Come here. Look at this Read it right there. I want to hear you Max krauss age 34 5 11 170 pounds for the complexion black hair black eyes. Well, all right Why did you give me a phony description phony the max krauss? I found that red hair and blue eyes I don't get it. None of this. What are you talking about krauss is dead? He was killed because I didn't know who he was and draw him out into the open What did this happen? It happened I was picked up the minute I hit town and followed who else but you knew what train I was arriving on And the hotel where I was stopping now wait a minute wait a minute I don't think you got right to jump at these conclusions. I hired you in good faith If you don't like the job They quit not for a while I stand a good chance of being picked up for questioning on that killing. I don't like that I want to know I want to know how it happened From here. It looks like you sold out to somebody and hired me to put the finger on krauss I don't like that either. Let me tell you something if I was crazy enough to do a thing like that I do it so nobody could prove what about the phony description It may have been a mistake. I don't know how it happened. I think we'd better find out and let me know when you come up with a story Johnny dollar from your place is madigan there. No, where is he? I don't know He got a phone call and left right afterwards. Was the call about krauss. He wouldn't tell me max. He was killed I've been scared to death ever since he left and I didn't know why I'll call back later and see if he's in Mr. Dollar Can't you tell me over the phone? No, I Won't you come up You're alone Okay, I'll take a chance. It'll be about 10 minutes. It was a five minute walk And I noticed that new york street seemed to be quieter than usual Inside the building I walked the two flights up to save the noise my arrival would have created by a way of the elevator I listened a few minutes outside a door without hearing anything And took the plunge I had the feeling you changed your mind and not come. I almost did There's nobody here. When did madigan say he'd be back? He didn't he didn't say anything I have a funny feeling about krauss's death But except for my getting mixed up in this mess. It was more madigan's fault than your fault than it was mine Why didn't he tell me it was krauss who was here if he told me that I probably would have believed the rest of his pitch Oh, I don't know Nobody really knows anything about jack. Not even you nobody You put three men on their way to federal court to sing and a few hundred wanting to stop them The lid is going to blow What do you want to tell me? I want I want to tell you where my brother is Huh? After what happened to krauss. Do you think that's why? I have to say it I'm in a two I think jack newbie things are gonna happen even about you showing up Knowing about it or planning it I know it sounds impossible, but I keep remembering things he said About how he'd have the government men eating out of his hand He was bargaining for leniency. He told me but why are you ratting on him? Because jack doesn't care about anybody but himself One of the threats to keep him from testifying was that I'd be kidnapped Huh, he'd known that max would be killed. He'd let him take me too You think he did know he hadn't let max out of his apartment for almost a month Tonight he ordered him to go I think he wants us killed so it'll make it look that much more dangerous for him Does it sound too crazy? Not exactly, but it's hard to prove I know that And I did a foolish thing after he left. I called my brother nippy told him all this I don't know what he thought, but I tried to call him again and I don't get any answer Where is he? He's insane, but jack Over on lexington brighten arms apartment 302 That's cozy How afraid of kidnapping are you? Oh, I don't know what to do I don't know how I can stand staying here and waiting Where can I go? Get a coat. I'll put you in my hotel room Expense gun item six ten dollars tipped to the hotel detective to see that she stayed in the room Item seven 120 cab fare to jack madigan's address I dropped my taxi a half block down and walked the rest of the way What slowed me was the sight of a couple of prowl cars parked in front of the building And even at that time of night a small group of them all that in a scattered circle on the sidewalk I saw the body but didn't move close enough to recognize it Hey, uh, what happened? Oh shooting anybody know who it is Not a whole country will in the morning. He was due for a big federal probe. That's jack madigan Where were you? I suppose they were more shooting right here than the whole picture. Hey, uh, pardon me Yeah When did it happen? You know, not exactly. They've been here quite a while about an hour anyway Can't find the medical examiner and they can't do a thing about moving them till they do Hey friend, wait till the editorials tomorrow night You got back in a hurry What's the matter your theory has just been riddled madigan's been killed. I don't believe that's what the honor spot experts say I was wrong about him What about nippy? I don't think your brother would have been there Were they the same ones that shot max? No How do you know cars were parked solid at the curb and madigan was too close to them He couldn't have been shot from the street like max was Do you think nippy would go to your place? No, he wouldn't go there. That'd be the first place. They'd look the first place. Who'd look I don't know why I said that Yes, I do The same thing aren't you? That I told him what I was afraid of and warned him That crossed my mind But I don't care who I can send it for madigan's killing as long as I can go home You seem to be the closest suspect You're not serious. You've given yourself a motive as far as I know you were with him last I wasn't he left the apartment If that's true, you've got nothing to worry about. What do you mean? What do you want me to do go with me and we'll both make a statement to the police You think I'm afraid do don't you? I don't know what to think about you. Yes, you do Because you found me in a mess like this. You think I'm as rotten as everybody else I haven't been But now I will be to protect myself. Well, how badly do you need protection? I know how the police are. They're just like you They don't care either who they pull in for jack's death You tell me to go with you and make a statement the police had loved that They'd love to count the whole thing off to jealousy or being afraid of jack wouldn't they wouldn't they? Ah, you don't touch me. I don't care what they'd like. Well, they would It'd be much better to take me to be laughed at because a star witness was killed right under their noses We can call them and find out. No It's easier to be rotten I'll give you my brother He is at my place Honey, you know I talked to him on the phone He said he'd wait there until he heard from me again Okay I'll go over there But I want you to come with me. Why? Haven't I done enough? Why do I have to see him? Come on. I don't want to lose you in case nippy isn't there Give me the key Yes, nippy You work, nippy, isn't it?  That's right nippy What are you doing here? What'd you bring him to? He made me do it. I asked her to make a choice between giving herself up for madigan's killing or giving the you Nippy, but the gun away nippy you've done enough is It's what he says true He made me do it He would have taken me to the police You know what they would have done to me But it's all right nippy. You can still work it out. Get away from me. She's wrong You couldn't work it out, but you may do yourself some good by giving yourself up Why did you do this vivian? Did you want to get rid of me too? Oh, don't say that. You don't have to let him do if you get rid of me Who's gonna take care of you?  Not him. I'm afraid of you, vivian You're going with me stay away from him. If he let go and stop fighting. I wouldn't hurt you. You will Vivian get it. I should have let him take you Give me the police I've had trouble enough with this group. You know, you didn't make it easy for me with that phony description Yeah, yeah, I know that description. It was given to me by madigan's boys. I should have checked it But don't worry a mistake like that won't happen again. None of your mistakes will happen to me again. Huh? You'll understand what I mean. It's true when you get my bill Expense account item eight same as item two item nine miscellaneous $2,500 expense account total $2,720 Remarks I'm holding my retaining fee until this matter is settled yours truly Johnny dollar Of course truly Johnny dollar stars Edmund O'Brien in the title role and is written by gill dowd with music by wilbur hatch Edmund O'Brien may soon be seen in the paramount pictures production warpath Featured in tonight's cast were sydney miller john daner clayton post jenette nolan and john mackentire Yours truly Johnny dollar is transcribed in hollywood by hymie del valle This is dan coverley inviting you to join us next week at this time when we will again bring you edmund o'Brien as Yours truly johnny dollar How's for trying to sing it again tonight? $5,000 in cold hard cash and $10,000 in fine prizes are waiting for the cbs listener who can solve the phantom voice mystery Then seymour will be on hand with those coast-to-coast phone calls And allen dale yurtini baird bob howard and the riddlers will be making the music and remember There's many a fine prize for solving the tuneful little riddle song that lead to the fan of voice mystery It's an hour of fun and music to entertain you and perhaps pay off Every saturday night on most of these same cbs stations here sing it again And now stay tuned for born mineral caravan which follows immediately on most of these same cbs stations This is cbs for havalon cassidy rides every saturday night the columbia broadcasting system


The Jagawa state government has treated 1.5 million children through its Malaya Control Programme. The just concluded seasonal Malaya Chemo Prevention Campaign was the instrument deployed in carrying out the treatment according to the coordinator of the Malaya Control Programme Billia Haruna. The exercise was conducted with the support of Malaya Consortium between July and October. The latest exercise is the fourth cycle of the Chemo Prevention Campaign across the 27 local government areas of Jagawa state.


So, me I can't understand, I have just escaped, I don't know if I can even call it an arrest or anything, but it was clear that when I was a Cheston police, those police officers had the intentions of picking me up, I don't know what was going to follow because look, I first, if I can give you the background, the background is that I was called to bring the cable that was used to tie my gardener, the footage and also come with my gardener and myself. Now, so I was not able to go there, that was I think on Friday, so I said, let me come on Monday 10 hours and that's how we went there at 10 hours. When we arrived there, we went into the CIO's office, who is the one who called me? And I found him, he was having a meeting with the officer in charge. The moment I arrived, the officer in charge left the office and went into his office and their officers are just next to each other. I told him, we have brought the footage, we have brought the cable and this is the my gardener. He said, okay, just hold on a bit, I'm coming. That's how he went into the next office of the officer in charge. He took some minutes and then he came back and he said, just wait, the officer in charge has just stepped out. He will be coming back, just wait, about 20 minutes he will be back. Now, I knew that the officer in charge was in the office because I saw him going into the office and he saw the CIO going into the office and the door was open. I never saw him walking out and this is upstairs so he didn't fly from his office. I knew he was in the office but then the CIO is telling me he has just stepped out. He will be coming back in 20 minutes, which was clear to me that they were waiting for whatever they were waiting for. So I just told my gardener to say, let's go. And that's how we left the place, got into the vehicle and left. Now, I've been arrested so many times, they have taken me so many times. I know the tricks and I'm very sure the intentions were not good. The intentions were not good, I'm very sure about it because we had given statements already. They wrote our statements and they only asked now bring the footage. So I'm very sure the intentions were something else. But the question that I'm asking is why is it that I've turned out to be the suspect or the criminal? When I'm the one that was attacked, I can't understand this. And look, if today they got us together with my garden, they get the footage, they get my garden, they get the cable, where would the evidence? From my point of view it looks like they want to erase the evidence because it doesn't make sense. It doesn't make sense. Why do they want to arrest me? What have I done? And they are saying, well, you are putting the army into whatever. The question is, even whenever a crime happens, the police usually ask you. They ask you, who do you suspect? They usually ask you, who do you suspect?  And according to us, we have given them the clues that those people, they are from the army for simple reasons. Number one, the guns that they had, those guns are not used by even ordinary police officers. They are not used. Even ordinary soldiers, you don't see them carrying those guns. Number two, the cable that they use, it is not a common cable that you see around. The cable that they use to tie my garden. It is not a cable that you see around. Number three, they themselves said it, tell your board investigation. Somebody says, let him stop talking about the army. Which criminal with no interest with the army would come to my house wanting to kill me and tell me, let him not talk about the army. How? How? And then, the other point is, when you are shooting in the air, criminals usually run away. They run. Those people, they even said, does he know who we are? Does he know who we are for him to be shooting? The other point, which criminal do you see after leaving a scene of crying? Puts a gun on his back and drives freely at the back of a van. Which criminal does that? Where does that, I mean, it's just, it can't happen. Which criminals do that? So everything from our point of view is pointing to the army. It's pointing to the army and this is the clue. It is now up to the police to investigate and tell us to say, well, it is not the army, but the here are the criminals. Otherwise, there is no way you can turn me into a villain when I'm a victim here. I can't understand, they want to arrest me. Why do you want to arrest me? Why do you want to arrest me? What have I done? What crime have I committed? In my own country, I'm turning to be a fugitive. I mean, I'm not a fugitive. I'm not running away. I'm here. What's going on? What is going on? You are in the HRE. Me, I can't understand you and your governance. This is nothing about what me doing something wrong.   And you say, yo, you talk too much. I talk too much. What do I talk about?   Tell me what I've done that you want to kill me for?  What is it? On what was that? On Friday itself, they came to my house, wanted to arrest me. They wanted to beat me. They stayed one hour outside my yard waiting for me. Come on, this is just not right.  But I'm telling you, today it's me. Tomorrow it might be you. This is how dictatorship operates. Dictators, you know, you can be there saying, no, no, no, it's okay. It's Shufatehari, it's Shufatehari there following. But when they come for you, you'll be sorry. This is really unacceptable. I can't believe it. They called me to the police not really to continue investigating. They called me there because they want to arrest me. It is clearly not interested in investigating this case. What they want is me. They know, and if indeed those people were common criminals. If indeed those people were common criminals. I'm sure, you know, government would have, somebody would have said something. But everyone is quiet. Why is everyone quiet? Why is everyone quiet? What happened here? It's something big. It's not small. You can't take this lightly. People with those heavy machine guns. Coming to my house. Jumping the orphans and you take it that it's likely. Rwenu, you can think that no, it's just Shufatehari. But this is dictatorship. This is dictatorship. And we will start disappearing. People will start dying. Because I would have been dead by now. It is very unfortunate anyway. I've left the police. I've come back home. I've come back home if you want. Come to my home. I've come back home.


You're still motivated to achieve and do your very best. Like for instance, we teach this to athletes, top level athletes. They have to be at the best of that game. But if they miss a shot or they blow a game, if they just beat themselves up, it's not gonna help their performance. They have to say, okay, well, it's part of being an athlete and you miss a shot. I'm just gonna get back up on that horse and keep trying. It also allows us to learn from our failures in a way that self-criticism doesn't. Because it's like, oh, okay. Well, normal to fail. Well, what can I learn from it? And it's actually more effective in that sense as well. What's up everybody and welcome to the show today. We drop great content each and every week and we wanna make sure that you guys get notified. And in order to do that, you're gonna have to smash that subscribe button and hit that notification bell. And if you've gotten a lot of value out of this, make sure you give us a like and share our videos with your friends. Welcome to the show. Dr. Neff, we're so excited to talk to you today. Oh, thank you for so much for having me. Johnny and I are huge fans of acceptance commitment therapy. We use it with our clients who are struggling with social anxiety and inner critic that keeps them from doing the things that they want to be doing. And what comes up a lot is self-compassion. And I'd love to hear your take on what is self-compassion? How do we define that scientifically? And then we'll unpack how our listeners can use that in their daily lives. Great, okay. Well, I mean, the easy way to think of self-compassion is simply turning compassion inward, treating yourself with the same kindness, care, support that you would naturally show to a friend you cared about. But the scientific definition, at least my model, which I came up with about 20 years ago, is that there's actually three elements to make it compassion, self-compassion. First is the kindness, which is kind of the most obvious, but also mindfulness. In other words, in order to give ourselves compassion, we need to be able to turn toward our pain. We can ignore it or shove it underneath. At the same time, we can exaggerate it and run away with the drama of what's happening. We kind of need some perspective, which is offered by mindfulness so that we can be kind to ourselves when we're struggling. And then the third thing, which is what makes it compassion or not pity, is other people, right? So compassion is an inherently connected stance. It's not like, whoa, is me. It's saying, hey, I'm a human being. I struggle like everyone else. So those three elements together make up a state of self-compassion. And when it comes to scientifically speaking, how does self-compassion actually help improve our lives? Well, the research is pretty overwhelming at this point. There's, I think, almost 4,000 studies at last count, including dissertations. So there's a lot of research, and it shows basically it's linked to reduced psychopathology, so less depression, less anxiety, less stress, less suicidal ideation, but also increased positive states of mind, like happiness and life satisfaction. And that's because, of course, even though it's aimed at suffering, it helps us reduce our suffering when we care for ourselves. The feeling of being connected and kindness that arises with self-compassion is actually a positive emotion. It's linked to more coping and resilience. In fact, one of the most powerful things that self-compassion offers us is the ability to deal with difficult emotional situations without being overwhelmed. It's like this armor we carry in with us to life that actually helps us get through the tough stuff. It's also linked to increased motivation, right? Some people think self-compassion is letting yourself off the hook, going easy on yourself. I mean, of course, if you care about yourself, you'll want to reach your goals. Not because you aren't good enough as you are, it's simply because you wanna thrive and be happy. So it's really amazing the literature on self-compassion and all the benefits it offers. Yeah, it's counter-intuitive. I think many in our audience would feel that being extra hard on yourself is how you achieve those goals and is how you push yourself past pain and discomfort. And self-compassion is seen in a lot of ways, especially amongst our male clients, as being too soft on yourself and not pushing yourself hard enough to reach those goals. So it does definitely feel counter-intuitive. Yeah, it's counter-intuitive. And I think that's because with our children, it's not so counter-intuitive. Like, yes, if you use the paddle, you probably will motivate them to setting, get good grades. But we know now in the parenting literature that you're probably gonna mess your kid up and cause all sorts of psychological problems. And then in fact, encouragement, support. I mean, it's not going easy on your kid, but saying, I believe in you, I want you to achieve, how can I help? That's gonna be more effective. And so the same with ourselves. Yes, self-criticism does work. We wouldn't do it if it didn't. But again, it leads to things like depression, anxiety, that undermines your self-confidence. I mean, it creates fear of failure.  So self-compassion is a more effective motivator, right? So again, you're still motivated to achieve and do your very best. Like for instance, we teach this to athletes, top-level athletes. They have to be at the best of that game. But if they miss a shot or they blow a game, if they just beat themselves up, it's not gonna help their performance. They have to say, okay, well, it's part of being an athlete and you miss a shot. I'm just gonna get back up on that horse and keep trying. It also allows us to learn from our failures in a way that self-criticism doesn't. Because it's like, oh, okay. Well, normal to fail. Well, what can I learn from it? And it's actually more effective in that sense as well. We drop great content each and every week and we wanna make sure that you guys get notified. And in order to do that, you're gonna have to smash that subscribe button and hit that notification bell. And if you've gotten a lot of value out of this, make sure you give us a like and share our videos with your friends. I think that's where the waters get a bit muddy that most people don't really understand true self-compassion. They see it as perhaps I need to treat myself. I need to do something special for myself. But for a lot of folks, it's about giving themselves some space, listening to their inner critic and being able to navigate it, understand when that inner critic is beating themselves up and then having some tools to work with that inner critic. So because those waters are a bit muddied and a lot of people don't realize that self-compassion is the key out of how they're feeling and their demotivation and where they feel burned out, what would be the warning signs or symptoms that self-compassion is something that we need to start looking at? Ah, well basically, if you're depressed, if you're stressed, if you're anxious, if you're, basically anytime you're suffering, the remedy is self-compassion, right? It's a way that we relate to any form of suffering at any moment. You know, and it can take a variety of forms. Self-compassion is the desire to help oneself be well. Sometimes what you need to be well is a good old kick in the butt. Sometimes you need to take a break. Sometimes you need to draw boundaries. Sometimes you need to protect yourself. Sometimes you need to rest. Really know from the outside can tell you what you need. Self-compassion says, you know what? My needs are important, not more important than those of others, but at least as important. What do I need in this moment to get through and be at my best and be well and happy? And so once, so basically to answer your question, how do you know if you need it? Very simple test. You can notice how you talk to yourself when you're struggling. And again, it's not just failure or self-criticism, like how are you dealing with the pandemic, for instance, or for some difficult situation. And notice how you speak to yourself and say, would I say this in the same kind of tone of voice to someone I really cared about? And if the answer is no, you probably need some self-compassion. For myself, I mean, A.J. and I both grew up in very blue-collar households. We had factory dads, who motivation was a little bit more of yelling and screaming at the house, which we've also picked up on. And I would say that we have learned to use that to motivate us. And for myself, the trick has always been when to learn to let go of that anger as fuel and turn it into something more positive. At least that anger, that stress at the beginning, there's always been a good start, but if you allow it to drive you, it can consume you. Yeah, so actually my latest work and my latest book is all about what I like to call fierce self-compassion. So compassion has two main forms, it probably has more, but at least two main forms. One is kind of a tender, gentle form. This is our ability to be with ourselves as we are, our flaws and all, to be with pain in a kind of a gentle, nurturing way. But sometimes compassion takes getting angry. Anger directed at the alleviation of suffering is very useful, you should be angry at social injustice, for instance. The Me Too movement, this is the self-compassion movement as women stand up and get angry and say, it's not okay for you to treat me this way.  Really, any behavior that's used for the alleviation of suffering can be a type of compassionate response. I have a whole chapter about anger, because sometimes we think of anger as bad and we're supposed to get over it or be these peaceful people. Anger motivates us, it makes us brave, it energizes us, it focuses us. It can be very useful. Now, of course, the problem with anger is very easily, we lose ourselves and it becomes personal and we start causing harm as opposed to preventing harm. But again, if you're aim is to prevent harm, anger is a very effective tool for that end. It can be anyway. Well, you mentioned at the start, pity. And we don't wanna get to a place of pitying ourselves, we wanna stay motivated to reach our goal. So how does pity balance with self-compassion? Is there such thing as too much self-compassion? Yeah, so people ask me that in a way too much self-compassion is a bit of an oxymoron. Because of compassion is concern with your well-being and you're doing something that's causing you harm, it's no longer compassion, right? So yeah, you may think you're being compassionate when you're really just pitying yourself or feeling sorry for yourself or just, I really am not gonna go into work today even though in fact what would be good for you would be to go into work, right? So compassion is kind of almost defined by the outcome. So it's always aimed at the self's well-being. So pity, the big thing about pity is that it's a isolated stance. So for instance, if I were to pity you, maybe AJ for your leaf blower situation, if I was to like, oh, I feel so sorry for you, you'd be like, you know, what, what, what, this never happened to you. But if I tell you that actually I was on Dan Harris's show and I had a leaf blower incident of my own, I've been there, then it's like compassion. And it's actually, it's true by the way, I did have a leaf blower incident. And that sense of connection, hey, I've been there, this has happened to me or this could happen to me, we're both human beings. That's actually what makes it compassion. So that element of recognizing our shared humanity is actually essential and helps us feel connected to others in our suffering where self-pity makes us feel isolated from others and the isolation just makes things a lot worse.


Our final speaker this morning will be Christy Kirschner. Dr. Kirschner is a physician in physical medicine and rehabilitation at the Mount Sinai Hospital and Schwab Rehabilitation Hospital. Her research interests include disability ethics, disabled women's healthcare, neurologic rehabilitation, and neuromuscular disorders. And many of you in the audience know that Christy was one of the earliest people to enter the field of disability ethics and rehabilitation ethics. Today, this morning Christy will talk to us on the topic from Quinlan to Ashley X, a retrospective on disability healthcare and the role of clinical medical ethics, Christy Kirschner. Well, it's wonderful to be here and to reflect that I'm on my 20th anniversary. So it's quite amazing to think about what the last 20 years of my work in ethics has been and how enriched it's been by the McLean Center. So thank you, Mark, and thank you, McLean family. So I want to just put a couple of premises out there. And I'd like to start with the fact that when I think about the seminal cases that have helped define clinical medical ethics since the 60s, 70s, 80s, I think many, if not most of them, have at their core an issue or question of disability. My second premise is we've not had a touchy-feely relationship with people with disabilities. Disability activists, disability scholars have not felt that the world of clinical medical ethics has understood disability or been their allies. And we've seen this in a variety of ways. And with these classic cases, a subterranean culture and counter-narratives about why the clinical medical ethics, legal bioethics world got it wrong. And I think this is exemplified by a quote from Mouth magazine which is one of the disability activist journals that really compares bioethicists to skinheads. So, like I say, not a real touchy-feely relationship. But a lot of this work really came out of the disability civil rights movement. A lot of people who were at the core of the disability civil rights movement were people with polio who felt that they had to fight for acknowledgment in educational systems and healthcare institutions for personal assistance and services. Paul Longmore is on the right, to your right, of this slide. And Paul was doing a lot of this early work. A professor at San Francisco State University had polio himself. He was one of the founders of disability studies. And he wrote this paper that I think is really a classic paper and still has stood the test of time about, you know, when you look at medicine and you look at people with disabilities, we have a clash of cultures. And we have a clash of cultures for many reasons. People with disabilities look at their lives very differently than non-disabled people in healthcare professionals. And part of it comes down to how we see the goals of medicine. So if you think about is medicine, you know, to cure people or normalize their bodies? Or is it to help them function in the bodies that they have to alleviate suffering? We began to see discussions about medical model versus social model underlying a lot of the tensions. And out of this work, not just in bioethics, but in terms of disability and human rights work, we began to see an academic discipline emerge called disability studies. And this is an interdisciplinary field. It has intellectual roots in the social sciences, humanities and rehab. And one of the things I would point out is a lot of this work is not work that healthcare professionals are familiar with. It's not in the medical literature. But they talk about, think about very deeply, what is disability? One of the starting premises is it is part of the human condition. Most people in their lifetime will experience disability. So it's not something that is unusual and out there, but it is part of the human experience. Bodies become old, frail, and disability occurs as we age. So the social model, medical model critique really laid out the issue that the medical model says disability is always negative. Our role in medicine is to try to fix, cure, prevent and normalize a person. Whereas the social model would say, well, not always. Disability can be neutral. Disability is oftentimes an interaction between the person and the environment. So a person may be disabled because the building doesn't have stairs. If they have a wheelchair accessible building, they're no longer disabled. So they really look at those interactional components, which when I think back to medical school mark and thinking about the biopsychosocial model and how revolutionary that was, a lot of what I think the disability studies world has been thinking about is really, is medicine truly about biopsychosocial? And now in my world, we talk about biopsychoecological to layer in the environment. World Health Organization and the International Classification of Function and Disease has really embraced this. So in disability studies, the stakeholder perspectives are critical. Who gets to decide what the issue is? Who gets to frame the question? What are those power differentials? Again, feminist bioethics, narrative ethics has done some of this too. But disability studies does acknowledge issues of stigma and marginalization. So if I had to capture sort of the major beefs, I think disability activists and disability scholars have had with bioethics, they feel devalued by the way disability is talked about. They feel like there's ignorance about disability and there's a lack of respect for the lives of people with disability. There are negative attitudes and we've got an abundant amount of data that says healthcare professionals and people without disabilities are not accurate in their perceptions of what life with disability is like. They consistently have a negative perception of quality of life that is not in sync with what people would say about their own lives. And we've got still lots of issues of lack of access, care, resources, discrimination in terms of helping to level the playing field so people with disabilities can participate. So we've had counter narratives. So we've reached a point, I think, in medical ethics where we would say, well, we've really kind of tackled a lot of the major issues. We've talked about autonomy and the importance of autonomy in healthcare. It's the preeminent guiding principle of Western bioethics. Competent patients have the right to refuse medical treatment including life-sustaining treatment. And we're still talking a lot about the importance of an advanced directive of what issues that would solve in medicine. So are these settled? Well, I think let's look at a couple of examples of what counter narratives have worked. Let's go back to the 80s with some of the seminal right to die cases. Elizabeth Bouvier, the woman with cerebral palsy who wanted to starve herself to death was admitted to a hospital in Riverside, California. Doctors put a feeding tube in. And Elizabeth, for three years, cycled in and out of the courts saying, I do not want that feeding tube. I do not want that feeding tube. I do not want that feeding tube. And the court said, competent patient, right to refuse medical treatment. And it became one of the seminal cases. But the disability activist were in the background saying, now, wait a minute. We're looking at her as being depressed and wanting to die because of her cerebral palsy. In fact, if you look at the Mike Wallace videotape interviewing Elizabeth Bouvier and interviewing people who testified in her case, the neurologist says, none of us can imagine what it's like to scratch, not to be able to scratch an itch, which was never part of why Elizabeth Bouvier wanted to refuse food and fluid. So the disability activists were saying, something funny is going on here. She's been disabled her entire life. That is all she's known. And she was not somebody who gave up, but she was feisty. She lived in the community. She got married. She was working on a social work degree. What changed? Elizabeth all of a sudden decided that she wanted to starve herself to death. And they had all sorts of stressors that they could identify. Her marriage had broken up. She had a miscarriage. Her brother died. She had lost her housing. She had dropped out of school. So they were talking about, these are stressors that could cause despair for anyone disabled or not. Why are we treating her differently? Another seminal case was David Rivlin in 1989. David Rivlin had a spinal cord injury. He had lived in the community. He had been going to the university studying to be a philosopher. He'd had a girlfriend. He'd been engaged to be married. Then he developed some new neurologic symptoms which should not happen with the spinal cord injury, which is a static injury. They evaluated it, found he had an aneurysm of the spinal cord. So he underwent surgery to try to attempt to repair that aneurysm did not go well. He ended up then later dependent. What changed for David Rivlin was he ended up in a nursing home for three years because in Michigan the Medicaid system only allowed him to get care in the nursing home with the ventilator. So David Rivlin after three years said I don't want to live.  And this was actually one of the early cases that Jack Kovorki got really interested in and helped to stimulate his work. Medical model, bioethics would say competent patient, right to refuse medical treatment. And indeed if you look at the tapes of David Rivlin and you hear the doctors who evaluated him they would say, yeah, he was depressed but it was really a rational response to a situation. The counter narrative was, you know, this is really not an act of autonomy. He does not have choices. This is assisted suicide. This is a forced choice. This is coercion. He has no alternative but to continue life in a nursing home versus choosing to be withdrawn from medical treatment because he spent three years trying to fight for a way to return to his own home in the community and he continued to fight barriers. So the sense of the people in the disability community was he did not have self-determination because he didn't have reasonable options. He didn't even have a wheelchair to get out of bed. He didn't have any capacity to get out of the nursing home and reintegrate into the community. So I'm asking the question now, what progress have we made in bioethics in resolving this cultural divide? How are we doing now? Well, I'm going to just point out, I think we've actually made some significant progress and I'm going to talk specifically here about some of the areas which I think have really helped to inform the right to refuse treatment, medical treatment in the context of disability. I think Eric Cassel's work is brilliant on suffering. The suffering is a fear of disintegration of the self. It oftentimes is not what people are experiencing in the moment. It's what they're experiencing in their minds in the future. Peter Ubel, are you here? I think if you have not read Peter Ubel's work on the moral imagination and how people imagine states in the future and how they anticipate quality of life and hedonic psychology, I think it's fascinating work. It's helped to explain this disability paradox why people with disabilities judge their lives to have much higher quality of life than non-disabled people and healthcare professionals could imagine. And I think the work of Jodie Halpern has also been brilliant. I think that she's helped us understand the role of empathy and the engagement with the patient in negotiating these situations. I wanted to break up a case that dropped into our laps two weeks ago and I don't know if you've all heard about this gentleman Tim Bowers but about two weeks ago he fell out of a tree. 32-year-old newly married baby on the way fractures his spine. He ends up in a hospital and the doctors indicate well we're not sure you're ever going to get off the vent and the next day the family says that it's likeness sedation we want him to understand his prognosis and let him make his own decision. And a sister who was a nurse said her brother wanted to talk but couldn't because of the ventilator tube still in place. The tube were removed, doctors were not sure how long you would live so she's telling this to him now. Did he want the tube reinserted? If he struggled to breathe and the patient shook his head no and the doctors ask him the same questions and he shook his head no and they removed the tube and he did live actually five more hours and died in the presence of his family and friends. So what's interesting is this case flooded the news. Now why? It's on CNN, it's in the Associated Press multiple blogs are talking about it and indeed in one day I don't know how many of you are on the MCW bioethics listserv but there were about 41 posts in one day. So is this such settled business? I think it's interesting why was it of interest? Why was it newsworthy? Some people felt like absolutely shouldn't be talked about anymore. One is settled and others are saying gosh the rapidity of this decision. So we could talk about this again as a tale of two or more stories simply a competent patient making his own decisions or saying well how could he possibly understand his circumstances and make a decision? And I think you know I'm not going to spend time going through this but to think about how does an intubated patient have a considered conversation when they're being brought out of sedation and they've had the immediacy of such a traumatic event understand this. And so one of the answers in terms of the disability community's perspective on this was from the United Spinal Association president a man who had spinal cord injury who said I think this was uninformed consent. He said in 1993 if I were in this gentleman's shoes I would completely understand why he felt the way he did and why he chose what he did but he also talks about what it's like to be in that state you're at your lowest moment you're at your point of greatest vulnerability and he talks about then how you're worrying about being a burden to your family and you know the despair and the suffering and how glad he was that time was taken and he was able to work his way through it and I think if you went back to the work of Jody Halpern she would help us understand what's going on here that in the face of substantial suffering the person's ability to have mental freedom to imagine possibilities, goals for the future let alone to challenge the preconceptions of what this condition may be is actually quite constrained and that is that therapeutic engagement a process that we engage with patients that allow them to make decisions for points of authentic self-determination and Ellen, thank you I used the same slide of the iceberg but I think what I would like to put forward is my third premises I would love to see those of us who work in medicine, bioethics have actually a whole lot more curiosity about what this life with disability is about it's much richer, more complicated deep with more potentiality than I think most of us could ever imagine and I'm still at that tip of the iceberg stage after working with the 25 years so that's what I'd like to posit thank you


So we can take enough to look at an important concept which we can call end-tiles and This is an important activity of mathematician Switches to take a look at a concept and ask yourself. Well, how can you generalize this? What can you do to make this apply to more things or to broaden our definition and one of the hallmarks of thinking? Mathematically is whether or not you get into the habit of asking How can I generalize an idea and in this particular case? We have this concept of the median and what does the median do? Well the median separates the data into two sets of equal size So the generalization maybe I can say divide these separate the data into a bunch of sets of equal size And so this is where our concept of end-tiles comes from we're going to separate the data into end sets of equal size Well, we could have seven tiles or nine tiles. There's actually only a few commonly used separations So one I could separate the data into two equal sets. We should call this a two tile or a duo tile But we just call it the median because we've already introduced that term But a generalization one of the common separations is to separate the data into four equal sets And this produces the core tiles We could also try separating it at ten equal sets. That's going to produce the deciles and then finally we might separate into 100 equal sets and this produces the percentiles as With the median the median is the value that separates the data into sets of equal size and Correspondingly the end tile is the value that separates the sets However, one important thing is that in common usage The end tile is usually used for the values in the equal sets as well How you speak influences how you think so it really is best if you talk about the end tile Producing or corresponding to the set and not to say that the values are in the end tile So for example, let's take a look at a bunch of data values Maybe it looks something like that and we'll note that the values here are actually in order Which is important because if they're not in order, we can't reasonably separate these sets and there's 12 values I'll count them up. There's 12 values all together. So I'm going to divide these values into sets of Four sets. I'm looking for the core tiles I'll divide it into four sets and that means that there's going to be three items in each set So this first set of three that first those first three values form a set I'll put a divider up the next set of three That'll be a next set the next set of three that'll be our next set and so there's my values there's my dividers and I'm going to have to determine what numbers actually produce those divisions and those are going to be the number that is between These two and as with the median will split the difference will find the number that's right in the middle So between these two values here That's going to be 3.5 between these two values here right in the middle 6.5 between these two values Well, they're exactly the same value So the number in the middle is the number itself and that gives us our core tiles And so we have our first core tile 3.5 this is the first quartile important to remember how you speak influences how you think the first quartile is the number and This corresponds to the values two two and three This is not the first quartile These are the values produced by the first quartile to get the values that correspond to the first quartile likewise, I have the second quartile 6.5 and again the quartile itself is the actual value and it corresponds to a set of data values for five and six Now note that the second quartile is also the median because it's divided the set into one two Quarters and one two quarters half the values are up here half the values are down here So the second quartile corresponds to the median the third quartile that third dividing point is going to be nine And that's going to correspond to the values seven seven and nine Now you'll notice that we've talked about the values in the first quartile values corresponding to the first quartile The values corresponding to the second the values corresponding to the third quartile But then we have said nothing about these values So sometimes we might say that they're the values in the fourth quartile But keep in mind that there's no actual fourth quartile value The quartiles are the dividing points and there's only three of them So there is no fourth quartile, but there are the remaining values


In today's talk on sergiocondition that we fortunately don't see very often and those are tumors of the Biliri tree. Now we see patients that are slightly older and we do have a male predominance and they present to us by and large with painless jaundice. But you've got to think of the anatomy of the Biliri tree and I'll link to some images in the description below. Just always think of the anatomy. We divide the Biliri tree usually in thirds when it comes to tumors of the Biliri tree. We have the lower third, we have the middle third and then we have the upper third which is really by the hyalum and the left and right hepatic ducts as they start going into or at least into the liver. Now the ones in the lower third and the middle third they present more common. They'll make up more than half of the cases and upper third will be less than half of the cases. The ones that are in the lower third and the middle third and specifically those that develop below where the common hepatic duct and the cystic duct combine to form the common bile duct. The tumors below that we are going to see the stention of the gallbladder and that has a name. It's called Kovosius sign where we have this painless distented gallbladder in a patient with jaundice. Now these patients have nausea, they have all patients really with cholangococinoma can have weight loss. They do feel unwell and they have proritus and then they have obviously this deepening jaundice. It is an obstructive jaundice so they are going to have dark urine and pale stools as we see with chilodocolathiasis as an obstructive cause of jaundice. So these patients with the bile ducts they really need confirmation of the disease and delineating the anatomy. When it comes to the tumors in the upper third we do have a bit of a classification for them. You might be asked about those. We have a type 1, type 2, 3 and 4 and really type 3 and 4 those are inside of the liver secondary bile ducts. 2 is will be above the hyalum and 1 will really be at the common level of the common hepatic duct. And remember that's above the level where the cystic duct is going to enter the biliary tree so you're not going to have this Kovosius sign with this large palpable gallbladder that we do see. Remember there's a special tumor we call it a clatskin tumor. That's really for tumors around the bifurcation where the left and right hepatic ducts combine to form the common hepatic duct. So it is all about imaging then. We will do CD scans, we will do MRIs, MRCPs, just to delineate the anatomy. And it is about receptability in these instances. So these patients really have to be referred to unit that deals with these sections. They are bigger sections if we're talking the lower third. We are talking pancreatic or diodelectomies if we're talking the upper third tumors. The problem is these might involve large liver sections or liver sections with maintenance of some form of intrapacted bile duct system still to maintain. And you have to hook up again, remember the hepatic ducts with the enteric system so that there is flow of bile into the bowel. So these are really bigger sections and they have to be done or you have to refer these patients as soon as possible. The prognosis is not so good. The further distal these tumors are, the easier they are picked up and the better the prognosis is and the easier it is to get resection. So it is all about resection with clear margins. That is the treatment for these patients. You have to get resection with clear margins so receptability is very important. These tumors remember they invade locally and they spread via the lymphatics. Many units will do a laparoscopy initially after deciding, after imaging, after delineating the anatomy with an ERCP, MRCP. Finding out exactly what is going on, looking at the reserve of these patients. Can they go through this major surgery? We'll add to that a laparoscopy just to finally determine whether the receptability is possible. And in some instances you might find deposits in the peritoneal cavity or other local invasions that were not seen on preoperative investigations. And that idea of going into the abdomen then for primary resection, that management plan is aborted at that time. So fortunately tumors that we see really, you must know something about it. It's very easy to answer questions on carcinomas of the bilirity to think about the anatomy.