Health care is complex, life is complex, suicide prevention is complex, but I truly believe that working together with our self-awareness, we can find a solution and implement solutions. For the sake of time, what I'd like to do now is just move into our panel session so you can get real advice, real feedback, have your questions answered by our esteemed panel. And the first person that I would like to direct my questions to is Dr. McCarran of UCI. Hi, Dr. McCarran. How are you? Good evening. Good evening, Bernadette. Good evening. Now, as you answer the questions, and maybe this is for each of our panel members, just briefly just go over anything that you want to say personally about yourself and some of the programs you may be working on so we can set a nice framework for our attendees. I'm going to give you three questions and just in a series of questions so you can just lump them together. And then so everyone will know is with the hill just Dr. McCarran and our other panel members will just continuously speak for about eight minutes or so. So my first thoughts are the film explores difficult and emotional subject matter obviously. And again, suicide is complex with no one cause and there are many warning signals that can be missed. How should suicide and mental health issues be discussed with students and healthcare workers who devote themselves to medicine? And how should self care be taught and reinforced in curriculum? And then finally, are the warning signs different for healthcare workers versus our other professions? And has COVID-19 increased the mental health issues due to isolation and other factors? Yeah, well, Bernadette, again, thanks for letting me be part of this. That's actually the first time I'd seen this documentary in entirety and it is sad. I mean, there's really no other way to put it. It's also concerning. But it's something that I know of, quick background. So I'm an internal medicine doctor and a psychiatrist. I finished my residency training in 2003. Right before I finished, there were no work restrictions in a little background. I would work routinely about 120, 125 hours a week for five years straight. And I've worked closely with medical students. I've been a residency training director for many years. And as a little bit of a disclosure, I do work at University of California, Irvine. And also, I also am part of the residency review committee for psychiatry with the ACGME. And we saw the ACGME listed here. So I want to note that and note also that my comments tonight are comments from me personally as a physician and not as a representative from UCI or from ACGME. Your questions are great questions and I think your first question is how do you talk to students and residents about suicide? And my answer to that, I think, is pretty simple and straightforward and that is directly. What I tell students all the time and pre-medical students and residents and early career physicians often is this. I say, this is hard work. This is hard work. And I view this and many physicians probably view this as a blessing. You know, it's a job where we get to really get to know people vocally and intimately. But it is hard work. You know, I think I thought back watching this documentary to the very first time I had to tell a family in the ICU in the room where their mother had just passed away and I had to explain what was happening in real time. And I was all by myself. It was one in the morning and no one had ever given me a class on it. There was no class. There was no instruction. And I just remember feeling deflated while it was happening and after for days and weeks. So I think as colleagues and as a community, it's best to speak plainly and directly about how this can be emotionally taxing. It can be difficult. It's uniquely difficult. I would say that physicians, students involved in health care are uniquely vulnerable, uniquely vulnerable. And so I would say we need to be direct, really direct. And I think we have moved in that direction. I would say over the last 20 years, we have a long way to go. But making sure that we look out for our trainees if they're working 80 often more hours per week is going to be important. The other question Bernadette, you asked me is our physicians and medical students in residence a little different when it comes to to non physicians, residents and students when it comes to suicide and getting help. And my quick answer is yes, with an explanation point. There are many reasons why perhaps I think some of the reasons might include the following. Number one, I think that people in this cohort, this profession, you know, don't have it within themselves culturally right because we join a culture when we're in medicine to routinely or easily ask for help and say that they need help. So maybe that's changing. I see some evidence that that's changing with with with many more opportunities than I had as a medical student to to get help and to to talk about depression and anxiety. For example, I know Dr. McCrae my my own institution UCI goes out of her way. I mean, I probably weekly I'm seeing emails to our residents to to our trainees saying, if you need help, this is where you go. This is how you do it. And so I'm seeing some changes. But really the culture is we are fixers. We are supposed to be healers. And sometimes it gets in the way if we're depressed and we're anxious and it just gets sidelined until it's too late. So I think we are in a unique situation and I'm really glad that that Bernadette that you and Monica and the others put this together. I think it's so important to start the discussion. So, and I'm really grateful to be part of it actually. Thank you, Dr. McCarran what I thought was interesting also is what you highlighted. And that's a big subject is culture. Because I heard you say the hesitancy to ask for help and creating those cultures where residents and fellows feel feel safe enough to ask for help when they need it, and having peers or or other superiors to be able to go to. So, you know, maybe that's something else that we can talk about later. I don't know if you have any more comments on that subject or. Yeah, I mean, I think it's a it's a culture not only a fear of getting caught and have me losing your license, but I think it's just a culture of us being in the position of healing the depression and healing the anxiety and healing the suicidal thoughts and not having them. Right. And I think that that's just that's just that's just part of the that's just part of the culture and analogy might be, you know, the plumber, you know, fixes plumbing stuff. But if something happens that plumbers house, you know, it's it's different it's it feels different right because it's happening to them right and so they have to deal with the plumbing issue at their house. And with with physicians and health providers in the field, you know, we go to work and it's just it's ingrained in who we are it's ingrained in our in our culture and who we are and, you know, to heal and it's often difficult to to stop and say, Well, wait a minute, I think I might need some healing. I might need some help. And I think we're making some progress over time slowly incrementally. But but I but I think that that culture is strong. I think it's strong. Thank you. Yeah, I definitely from my own personal experience, I think you just don't know if somebody's having those thoughts or if they're depressed so creating a safe environment and starting early with that type of culture so so important. Thank you so much. Dr Smith, I would love to ask you. I know you do some coaching as well you're in this film, which is very commendable. And talking about the mental well being of our residents and fellows and other health care workers. And how is that connected with the ability to provide excellent patient care. And then also on the other side, how is that connected to patient harm. And then my other question is, it's understood that not seeking help we can become, you know, someone can become overwhelmed. And which we saw in the film delusion in their work, burnout and serious conditions. What are the barriers for the health care workers to go out and seek that help. I know we talked a little bit earlier about the culture and some other things but what are what are the barriers that you you have identified. I think that's a really good and important question, right is to observe it's it's the water in which we swim. You know you can't really see it because you're in it you don't really recognize it. But really we are living in a society and a culture where there's a lot of stigma for mental health help and for saying that you're struggling at all. So I think de stigmatizing mental illness de stigmatizing distress I mean the data is half of us, half of us are burned out. So why are we acting like we're not. And so I think people have talked to only recently like when I filmed this, it was about maybe three years ago or so. And I had not I had just lost a student to suicide. And I had not yet become comfortable talking about how deeply and profoundly that affected me and how my own thoughts were intrusive. And it was incredibly difficult to live in my body with those thoughts coming so commonly and intrusively. And then I went what happened to me for instance as an example is I went to at a conference that I was hosting at Mount Sinai I was one of the hosts. And someone spoke who was a suicide expert and he said we need to stop other ring. We need to say we need to stop saying here's the data on physician distress and suicide. We need to stop looking at like other physicians and we need leaders to stand up and say I I had this. You're not alone. There's nothing wrong with you. You're human. And so he said that and he showed this film actually clips from it and I co-facilitated a workshop with him right afterwards and for the first time ever. This was maybe one or two years ago. And I was like me too. Me too. And I'm going to tell every dean because it was a conference of deans and directors. I was like me too.  I'm going to tell everyone right like we need to destigmatize this. I'm a full professor. A very respected person at my university. And we need to say hey look it's okay. I can still practice clinical medicine. I can still be an esteemed professor. And we're working nationally people are working on it because every state has their own licensing questions. There's a lot of fear around those licensing questions and wondering what might happen if you seek treatment if you seek medication. And I think a lot of that is over amplified in a physician's mind that or in a medical students mind. I advised historically I advise medical students for a living and in my role at the university. And so they would feel if they took a year off or a block off or a week off that they would be forever stigmatized and we just had match day. And those students who took a year off even for mental health issues. I mean every program director knows this is just a fact of life of being in medicine. And as long as you have your story of like I was struggling I got help I'm so much better. I have all the tools now. Right. Someone who struggled and is on the other side is actually better because they know the tools. They know they can access resources. So I think that it's almost there is stigma, but there's also sort of like this false belief about amplifying or over amplifying the stigma that's there. I think that's one of the biggest barriers. And I think particularly during the pandemic it's been an incredible opportunity for physicians to speak up and say and try to help each other first of all and say look, we are hurting. We are suffering. We have PTSD. We are depressed and there's a national physician support line that's all volunteer that many of my friends and colleagues psychiatrist volunteer for. It's available to physicians not just to her suicidal, not just to her who are depressed or have anxiety or PTSD, but are like, I just kind of can't take it anymore. And just reach out. And like we have in the comments here in the q&a there's like, I'm in attending there's no duty hours for me. Right. Like, yes, we are human beings and like the numbers that this person puts in here. 11 patients per half day 80 unopened inbox messages like I typically had 100 inbox messages at all times. Like it's in the human, the demands that they put on us. And I think it's up to us now to believe that now is the time particularly with the attention on physicians during this pandemic to say, we're human too. We can't do this anymore. This is not good for us. And it's not good for society to continue to ask us to do this. So those are my thoughts. Thank you very, very much for those thoughts and what you shared.   It's an unbelievable, no one even can comprehend it, nor want to live through it. So let alone that you may have those thoughts makes it even more compounded. And I think you're correct about the culture currently with COVID, you know, with every downside there's always a great upside and to take advantage of that upside. And I think that, you know, this is a good example of taking advantage of that upside and really, you know, with the wave of talking about mental health issues. Now, I think this is very, very helpful. So thank you and your resources later if you'd like to post those those mental health resources would be really great. Thank you so much. So, Dr. McRae, you do a lot of programs at UCI with wellness for the faculty and the residents and their programs. Can you please tell us about some lessons that you've learned some failures and successes of actually reaching out and getting that type of culture moving forward and getting the residents and faculty to talk about mental health and wellness. And then you can conclude by talking to us maybe giving some advice or three top initiatives that somebody that's listening right now could start to implement or bring to a meeting or get their team to rally around and that could be faculty or students as well. Thank you, Bernadette, for inviting me to be on this panel. It's an honor to be here and it's an important, important topic I'm pushing my heart, and it was great to hear what Robert and Sonny were sharing. And I just wanted to echo some of the beans that they touched upon in terms of changing the culture. And Robert's right that Dr. McRae, I'm sorry, is right that we look at ourselves as being fixers. And it's really hard to release that role and ask for help. And also during this COVID pandemic, as Dr. Smith was talking about, we were reinforcing the pressure that is placed on physicians calling physicians heroes. I mean, again, it places more pressure. You're not supposed to be asking for help. So working on changing the culture is number one. And it's going to be ongoing hard work, but something that has to be done. And second, regularly engaging leadership in the discussion and the actual work on our well-being initiatives. Those are the two critical pieces to this changing culture and engaging leadership and looking at this as an institutional problem and something that we're going to fix as an institution and also as the culture of medicine. We really have to shift the way we look at others and destigmatize mental health. Some examples of what we've been doing over at UC Irvine. Three of our largest residency programs have started to do automatic check-in sessions. Semi-annoy for our residents with a psychiatrist. The residents have the ability to opt out, but these appointments are automatically made regularly. And I would say the vast majority go, and it just allows the residents of those to get connected to someone. A psychiatrist, a therapist makes them feel more comfortable accessing their health when it might be needed in the future. And also it helps destigmatize mental health and makes it okay for us to ask for help and recognize the stressors that we're under. We also developed a faculty peer support program. We had Dr. Jerry Shapiro from Brigham and Women's come over and train faculty. She found that the peer support program over at Brigham and Women's is one of the first of these kind of programs in the nation. This program has physicians proactively reaching out to their colleagues. We're going through an emotionally distressed event, so it could be that there was a medical error with an impact on someone. So this faculty member that's attending may not otherwise talk to anyone or seek any support, but this is just, we're proactively reaching out to our colleagues. And we try to open the door, start the dialogue, get them permission to talk in a confidential safe space. Again, otherwise these physicians will just try to power through and not say anything. We also are coordinating debriefing sessions for the entire healthcare team, 24 to 40 hours after an emotionally distressed event involving a patient, or trying to create again that safe space to process what happened. We also have an interactive screening program that's hosted by the American Foundation for Suicide Prevention. This gives residents and faculty an opportunity to anonymously complete an online screening, so it will just take a few minutes. And then within 24 hours, we have a counselor at UCI review their responses, and then they directly connect, well through the website, so it truly is anonymous, they connect with that person, they give him some resources, but also an opportunity to meet in person. So we have counselors at UC Irvine, and she actually provides services to all of UC Irvine employees. And it's a lot. The residents actually make up 30% of her caseload, and it's a lot. But what I will highlight is that I think that this screening program that's given to everyone is actually letting people know about this resource and they're utilizing it. So I am glad that they are. We're also working on forming partnerships in the community to make sure that mental health services are easily accessible in a timely manner. As Dr. McCarran was saying, I mean, the residents will just keep pushing and pushing, physicians will keep pushing and pushing, and they won't make time for themselves. And so we need to make sure that they do have an easy time to make the appointment when needed. So we have at UCI psychiatry, residents and faculty can directly email the medical director to schedule an appointment rather than going through the front desk. And then we also have one of our mental health practices in the community have an appointment line just for UCI providers, so someone will pick up immediately. And then education and just continuing the dialogue, reducing the stigma, and we're trying to build the culture that physicians are not supposed to just monitor for signs and symptoms of depression, or risk of harm in themselves, but also they have a responsibility to look out for each other. I want people to reach out, speak out. We need to have that dialogue going. In terms of recommendations for others who may want to start programs at their institutions, it's really getting leadership engaged. To get the financial support you need real FTEs, real money to back positions with protected time to wellness. It can't just be people volunteering their time you have to get money behind of this. Money behind people to have the time to devote to this important initiative but also funding to support various events and activities. But in addition, we do want well being champions within each department. Thank you Dr. McRae. I have a question you what everything that you spoke of was very detailed, very in depth, very thorough, which was is fantastic. And that is a lot, a lot of work and and I just had this the random thought it was, has there ever been any type of template? Is there any, have you ever put this down in a paper or in any documentation that can be used as a guide? I'm not personally, however, that being said, the National Academy of Medicine, ACGME, DLAMC, all of them have these great great banks of resources and they have guides as well. So fortunately, physician well being is at the forefront in terms of many of these national organizations focus. So there's a lot of information out there. Okay, great. Thank you. And what I'd like to do now is see if our panelists have any other comments or thoughts and and see if we can get some questions from our participants or attendees to see if they would like to ask our panelists any questions. So first, are there any other thoughts by our panelists? I had the thought. While the last person Dr. McCrae was just speaking about the universal screening and the anonymous availability of that people who are interested here if they want to implement that they can go to the American Foundation for Suicide Prevention and they look about the screening tool and work with them. We use that at our university as well and my friends and colleagues implemented it and you never think you're going to be the one who's going to need it, right? Like, oh yeah, we fill this out all the time, right? And I literally not only was colleagues and presented and have published academic journals, right? With the people who create and implement these systems. I also became a recipient of that where I the anonymity of it to me at first because when you're in shame and stigma, you can't see it's okay to get help. So I went to the anonymous system. I made a fake email. I made a new Gmail account, right? I did all the things. I didn't want anyone to know it was me. And it got me help. And now I can speak, right? So like I think the pervasiveness of those anonymous things and the multiple ways in that she had talked about some for some people peer support feels safer. For some people an off-campus therapist feels safer. For some people, someone labeled a coach feels safer. Like any way in to help seeking behavior and normalizing help seeking behavior is the goal. So I just wanted to speak to she has this like platter of different ways that people can get help. And I think that that's important too. And I really just want to echo what she said about put real FTEs. This isn't about like, you know, a gathering, not that we're gathering because of COVID, but this isn't about like one thing. This is like this. This is the time to ask our institutions to really step up. I was actually thank you for articulating that so well because I was thinking about that as well when Dr. McRae said that I thought, wow, that is that's almost clever. That is so brilliant to really introduce this and really stay in check with your residents with the screening program. And obviously it works well. Any other thoughts from our panelists? Okay, let's open it up for Q&A and I'm looking over here on the right side. And there's a question from Susan Lee from to the panelists. And it states, are you aware of any other medical schools that have this proactive help available for their residents? Which ones do also the documentary mentions that medical schools surveys among their medical students rates of depression rates and anxiety. How can the general public or prospective medical students access this information? Anybody would like to take that one on? I'm happy to I'm always more than happy to speak so feel free to keep me in check. But I mean, this is a problem at every medical school. There is no medical school where this is not a problem. This is a problem of the culture of medicine. So there's a randomized control trial that shows that around 20% of interns within three months are having suicidal ideation. So within three months, you know, they had just matched. They had the best day of their life. It's like the moment that is the culmination of all your hard work. You're so happy. We throw you an internship three months later. One in five is entertaining the thought they'd rather be dead than continue in their internship. This is a systemic pervasive problem. There are many, many studies that over the course of 50 years internationally across medicine showing the rates of suicide and depression and burnout and they're published in JAMA mainstream articles. This is not a new problem. This is not a local problem. If you have a loved one in medical school, chances are there is significant distress where they are. So and do other schools have programs like Mount Sinai where I was, they require. It's an opt out mental health screening and just like UC Irvine is one of the leaders as well. There's many schools that are coming together to try to lead this movement, but there's a lot of work left to be done. Thank you. Would you with Dr. McCarron or do you know what like to add on? In terms of the question regarding where do you get the information regarding the medical students rates of depression rates of anxiety? It's a good question.   So we get a general sense of how we're doing, but it's, you know, we can always continue to work harder. And unfortunately, like Dr. Smith said, this is a problem everywhere. So I don't know of where that would be available to the public. And then again, as Dr. Smith says, schools are working on being more proactive and providing support because I think we're all realizing that people aren't necessarily going to ask for help themselves. So we need to just place the resources right there and make the appointments and they cannot doubt if they want. You know, in Bernadette, I would just add that I would say 10 years ago, you know, when residents and faculty were filling out surveys about how their residency program is doing, there was no wellness in there. The word was not used, right? I mean, certainly when I was a resident, I was like, what's wellness?  But fast forward to today, and it's a slowly evolving process. You know, wellness is a big part of the evaluation of how our residency is doing. It's integral to, you know, the success, you know, at least on paper. Again, I think we have a long ways to go, but finally we're starting to include ideas of provider wellness when we're evaluating training programs and medicine, which is a good thing. And I'd also add that it's interesting there's the, like, incidence prevalence, but there's also the utilization data. And at our medical school, we actually, for many years, have looked at it as a good thing when utilization of mental health resources goes up, because we think that means that they're actually addressing the issue. So we don't want, like, we want the incidence and the prevalence to go down, of course, but we want utilization of psychiatric services. We want that number to go up. Absolutely agree, Dr. Smith. I get monthly reports from some of our key practices and therapists. I mean, obviously they're not sending me names, but they'll just say, I just want a sense of the utilization rate from month to month. And it does comfort me to know that people are using the services because we know that it's a problem and I would rather have high utilization rate. Totally agree. One question I did have. When you do have incidents, do you have a certain protocol that you have in place or is that highly recommended that is also included in your programs? 100%, you can go to the American Foundation for Suicide Prevention website and find what to do after an event, what to do after a suicide. It includes immediately after a suicide and for the leaders of the organization, they also have one for high school. I mean, we had to implement those protocols. It's horrifically painful. Suicide contagion is very real. It is very real. It is very important to talk about it as soon as it happens as openly and with as much support as possible from day one. Yeah, agree. It's something that I think a lot of institutions just don't want to think about it, but you have to. One topic that I present at different conferences is how to have a crisis intervention plan in place. It's like not the work that people want to do, but you've got to have it in place. And then we also have a protocol in terms of like the level of urgency and what are all the resources. So if you need to see someone now, this is what you do. If it's urgent but not imminent danger, then this is what you do. So we have different tiers, bank of resources. Could you speak to maybe this is a question for Dr. McCarran a little bit about the peer-to-peer relationship and the support system there or peer-to-peer training? Yeah, you know, well, I mean, I think it's lacking generally speaking in academia and probably in community programs as well. You know, there are ballot groups that some institutions can use either formally or informally. And these are groups where, you know, providers can come together and talk about the badness at work, the struggles, the strain, the uncertainty. You know, that happens in the world of medicine. I don't really see a lot of those happening, you know, in academia and I see Sunny nodding her head to the affirmative. And I think they should happen more. I don't necessarily think they should even be officially organized by an institution. I think that they should be organically created when possible and supported. I don't think there's really a lot of peer-to-peer support, unfortunately. Now, examples of peer-to-peer support, I think in institutions that I've been at at UC Davis and also at UC Irvine would be immediately after a suicide. A lot of institutions will kind of want to shy away from it. Fortunately, those two institutions that I've been with have faced it head-on and quickly and in a very, very supportive way. They don't waste a minute. And that's when peer-to-peer support has really, I think, been strong from what I've seen in academia. It would be nice to do it in a preventive way, though, you know, if that's possible. And again, I think that's one way as an institution, as a profession, we can probably improve. Thank you. You know, we have a couple more minutes and I don't see too many more questions from our audience. So, oh, somebody did ask about nurses and wonder what the pressure is like for nurses and any data. And I'm also wondering about the opiate use by doctors. Would anybody would like to address that question? I, you know, so I can talk a little bit about opioid use or misuse. You know, it's prevalent. I thought in my head I can't give numbers, but it's pretty substantial. But that's also often commingled with misuse of other substances like alcohol pretty commonly, which is not good personally for the providers, but also professionally. It can be obviously problematic as well. You know, and so, I mean, chronic pain is the number one reason for a YA patient is going to present to a provider pain, physical pain. And as providers, we're also humans, so we're going to have pain as well. It often just difficult to deal with it. We also have more access to it as well. So we have more access to pain medications, narcotics scheduled pain medications as well. Bernadette, I'd like to ask the panel, we have a couple of questions around fatigue management and communication bombardment. How do you deal?  The information overload, the documentation overload, the nonstop email inbox, that is a challenge. What I have personally been doing is if I leave my schedule open, I'm going to get scheduled for a meeting every hour on the hour. So I actually schedule just admin time for myself and I schedule the time when I'm going to go work out. I'm obsessed with scheduling everything, but if I don't, it's endless, right? And so I'm trying to also change my mindset that it's okay when there's a bunch of emails sitting in my inbox and they're unread, it's bothersome. But it's never ending at the same time, so it's just kind of getting used to that and being okay with not responding within six hours. I mean, I think the expectations have gotten a bit ridiculous in terms of email. It's almost like you're texting, so you should respond right away. And it's okay when things just kind of sit and being just having that mindset that that's okay. It's been tough, but that's what I'm personally trying to do. Dina, that's hard to do for so many of myself included, but I fully agree. I mean, I think using an analogy, someone coming in, they haven't seen their doctor in 15 years and their blood pressure is really high. Their diastolic blood pressure is 110 or 115. It's our impulse to say, oh my gosh, we got to get this blood pressure down now without thinking this patient's had this high blood pressure for years and years. Let's do it slowly. Let's do it in a sustainable fashion. And sometimes it's okay for inboxes full. No one's going to be hurt from that if they get a delayed email response to be one with that. And it's hard to do, but that would be my suggestion. And then the other thing is, let's say you're working at an institution where you're getting tons and tons of EMR inbox messages that you don't have the support you need. And you're seeing patients every 12 to 18 minutes. Well, maybe that's not sustainable. Maybe that's not sustainable for a particular individual at a particular job. So that's another thought. I think that's some wisdom that I'll just echo there is that the current healthcare system is not sustainable. It is for human beings to spend 40 years right of their career in their life with an inbox with 100 things in it and expected to see someone every 12 minutes. It's just not sustainable. I think that this the place that we are right now in healthcare is an accident of history. Our insurance system is an accident of history. The EHRs were kind of rushed out in 2008 because of the American Reinvestment Recovery Act rights with some bonus money to revitalize the economy. And one analogy we use is we would never ask a judge to be the court reporter. It wouldn't even make any sense for the judge to go home at night and type up what happened. While their kids are being fed dinner and after they go to bed. So that's because we protected the judges as they developed right over time they've been around for centuries just like healers have been around for centuries. But for some reason through some odd be perhaps because we're so used to self sacrifice and whatever you put on us we work harder we'll work faster we can do it we can do it. But it just doesn't make sense. For your physician to go home and a day or a week later be charting on what happened during that visit. And it takes away from our families from our children. Doctoring when children now imitate doctoring I don't know if any of you guys have this in your household but I do in mind. My son when he imitates doctoring he gets out his computer and starts typing. That's not what doctoring is. We are the most valuable resource in health care. That became even more obvious during COVID. We could get some more ventilators right that came over from other nations they would fly them into Italy. It's the human beings who can operate those ventilators that can't be made overnight or in a week or in a month or in a year. We are uniquely valuable resources and we've become the most expensive data entry clerks who are willing to work 24 hours or 18 hours. Again this doesn't happen in any other industry. Why do we allow it in medicine. It's fascinating and it's time to start asking those deeper questions I think. Very well said. And as we're moving to conclusion of tonight's program. Perhaps with the way you kind of teed that up Doctor Smith I'd like to ask our panelists you know if you had just one wish list. You know so we can in a nice positive note what would that be what would that be to really help our physicians and our health care workers. With their mental health issues and any wellness programs. Because like you said we do need them and we do need all of you so thank you again for participating so if you'd like to just maybe one by one answer that question that would be wonderful. Sure I'd be happy to I think about this all the time so I'm happy to share my wish list. I would love a wellness center with therapists and psychiatrist dedicated solely to our physicians available 24 seven that's my wish list. And then you just kind of walk through the door and it's really confidential and comfortable there. The other item on my wish list is that there is enough ancillary staff support staff so that the physicians can focus just on the active doctoring or focus on just their education. Sunny I'll be brief and let me just say that I really heard what you said and I've never thought about it that way before so I'm going to be thinking tonight about what you said. My wish list would be kind of different it would be to look to relook reassess at how we can most effectively meaningfully and sustainably optimize the practice of medicine. And if we do that, I think it means wellness for providers. I believe that and I think if you if you truly are optimizing medicine, then you're going to optimize wellness for providers. I think it goes together and in some ways I think we're missing the mark and that that would be my wish list. I would say for me, I think it all starts with seeing the physician as a human being, because we asked them to do things that are really not human we treat them like robots and machines and cogs and wheels and I recently in my coaching program we invited in Martha Beck who's like an incredibly well known coach, Oprah's coach, etc. She spent two Saturdays with us doing workshops, and then she later said, those were the most profound two workshops of my career. Because she could not believe the things that the physicians were telling her that we were asked to do, or that we implicitly did without being asked, coming to work while you're having a miscarriage, coming to work while someone is having surgery that you love, not going pee, not eating, not like all the things that so many physicians believe is the right way to be a good doctor. I think is by denying a little bit of our humanity. Yesterday in my group, someone wrote concern because her manager was concerned that people complained they saw her taking a 10 minute walk. 10 minute walk literally actually objectively people complained because they thought that meant she wasn't working hard enough. She's like I work through my lunch every single day. I chart every single day at lunch. People don't quite realize physicians don't get lunch, at least for the most part. Yes, there's many who do, but they are kind of the rare exception. We chart at lunch. We are always working, always working. So it's just that's the culture that we're in. And I think starting to give us enough space to realize that we need all the breaks everyone else does. We need all the compassion everyone else does. We were called residents back in the day because we lived in the hospital. We no longer live in the hospital, but there's just a lot of that has been carried forward about the way in which they addressed in this documentary. And even as a woman, for instance, medicine used to be practiced by men who had stay at home moms carrying for all the stuff. And that's no longer the case. So it's like, how do you change everything when all of society has changed, but the rules for how we doctor hasn't really changed. So those are my reflections. Well, again, I'm speechless and I really, really thank you all from the bottom of my heart. You've contributed so much and I hope our guests have heard quite a bit from you and learned something and are motivated to move forward and continue the conversation. Because we know the conversation does save lives. And again, as your moderator, I thank you for this honor. And I'd like to turn the program back to Monica McDade. Thank you, Bernadette. Wow. Blessings and thank you to all of our panelists. Incredible job, Dr. Smith, Dr. McCarran, Dr. McCray. Really appreciate your expertise and sharing your wisdom and your compassion. Bernadette, I know this is a subject near and dear to both our hearts. I lost a brother 36 years ago, who I still think of every day. He wasn't a physician, but the act of suicide. It only takes a moment, but it lasts a lifetime for the loved ones left behind. So from all of our hearts to yours, I hope that you will be able to start a dialogue with someone and reach out if you think someone is struggling. We will be sending out a survey as well. And if you do feel inspired to make change, please consider a donation. Many of the proceeds from tonight's screening will be used to update our mental health actionable patient safety solutions on our website. So we want to make sure that they're refreshed and current and relevant to physicians and nurses in today's working world. Thank you to all of our attendees. We really appreciate your registrations and we hope to see you at our next event online. So with that, enjoy the rest of your evening. Thank you.


Matt, I was sexually abused when I was four to the age of seven.  Absolutely. And that's actually a really, really common thing. So depending on what happened to you early on in your life, depends on how you'll kind of interact with people and situations later on in your life. And so if you were abused sexually or physically or emotionally or something like that, when you're younger, depending on what kind of meaning you created out of that depends on what ends up happening later on. So if you create meaning that says that you're only worth kind of these certain things because that's what somebody used you for, then what you might end up doing is trying to prove that you're worthy in other ways and you just continue to try to prove and prove and prove and prove. And you have to break that cycle. You have to break that pattern that you get into and you have to change the way that you look at your life and change your story, change the way that you think about your story. And I'm not trying to say that any of that should be discounted or anything that you experienced should be discounted in any way. But what I am saying is that the way that you look at that event, because some people will look at that event and say, I'm broken, I'm destroyed, I'm not worthy, I'm a victim to life. And other people will look at it and they'll say, you know what, this has given me a mission to create something bigger and better in the world. It's put me on a mission to make sure that this doesn't happen to other people, to create awareness around this problem that's happening in the world.  And so it really depends on the way that you look at it. And my suggestion is that you do whatever healing that you need to do around that and you spend some time reshaping the way that you think about your life now. And you don't have to go back to that period. Some people will talk about healing work and they're like, oh, you have to go back and experience all the emotions and stuff at that time. You can do that. That is one way of doing it, but you don't have to.  What you can do is change the way that you think about yourself, change your identity, change your story about who you are and what your life is about and go in this concept that I call identity hacking. And identity hacking is just looking at the way that you think about yourself right now. So if you think about yourself as, like I was saying before, if you think about yourself as broken, as not good enough, as disposable, as all these different things, right? Those things will define how you experience your life and how you interact with different people, especially men and relationships in general. And so what you want to do is figure out who you are at your best. Who are you when you're living your best life, right? What characteristics do you have? How do you act? How do you behave?   Again, not to like discount anything that's ever happened to anybody, but at the same time, who you are when you're living your best is your most, for most people, it's they're inspired, they're confident, they're strong, they're going after their life. They're creating the things around them. They're responsible for who they are and the results that they create in their life. They're filled with love and enjoyment and happiness and excitement and all these things, right? And, you know, what you can do is you can figure out, okay, when I'm being that way, when I'm that person, you know, who am I? Like, and name it, actually create a name around that person, create an identity for that person and then take on that identity. And whenever you're feeling sad or you're feeling down or you're feeling lonely, what you can do is you can say, you know, am I being this person, right? And some people will say the goddess, right? Or the queen or, you know, powerful or, you know, sometimes they'll give it like an actual name like, like Susan, am I being Susan right now? Or am I being this, this other person that I don't like being? And so what you want to do is you want to get into that person that you're being at your best as much as you possibly can and really integrate that inside of who you are and try to get into that person on a daily habitual basis. And eventually, like I said, what you'll do is you'll start creating a new path. And that new path will make you feel inspired and powerful and strong more of the time.


What's going on, everyone? Sam here with late in sports cards, ripping 22. Penidu, Don Russen, Impeccable, football hobby, two box mixture, number 23, random team style. There's a look again at your random results. As always, you can find these on the website under the results tab, as well as the link in chat. So good luck here, guys. Let's do it. She always does that when you top lose. Do you like stare at the thing? Nakobi Dean, I want to say. Yep, on the missing name plate, Rookie. Nice one there. He'll always just be like staring at the sheets, like double check him like it's everything okay. He's like, yeah, I'm just checking. Dude, killing me. Olave Rookie, Sam Howell, The Rookies, Kyle Hamilton, and Kurt Warner. Red is a pure strong junior. Trayvon Walker Rookie, hopefully lose to the Sharks. There's a jersey number Derek Henry that's going to the Titans, 3 of 22. Hawks blew a eight point lead in the last two minutes.  There's a nice 10 of 10. That's Jersey Kings off patch auto for the Browns. Wow, I was not expecting that is cream hunt. Browns, Steven W, nice one there, buddy. Too many wins. They're doing too well. No, no, no. Hawks Twitter, like like Atlanta Hawks, like fan Twitter fans, like fans on Twitter were saying that, like jokingly. Everyone else is like, dude, relax. Okay, to be fair, it wasn't Hawks Twitter, it was one guy on Hawks Twitter was saying that. One more on Santa Fire, Quinn Snyder. Then it's what? Second game as head coach. Christian Watson, The Rookies, Son Haskins, and Montez Sweat. There's passing the torch, nice. Marshall Falk and Jonathan Taylor, two of 49 patch and patch. Nice one there for the Colts. You want a four game losing streak and make up some ground. George Pickens, there's a Jamar Chase to 100. John Dotson, Rainn Wilson, fans of the game and Trevor once. We need to get an auto one of those. Yeah, for a curry. That'd be sick. They need to do more than just what was on the checklist now. Resol, Tram McBride and Heinz Ward. Jags held up their end of the deal. Jamison Williams, Drew Luck, Jordy Nelson, Joe Burrow. There's a Carson Strong red. I don't know why I just remembered this. I guess because the Carson Strong. We were ripping NT Collegia, I think last Tuesday and Sky Moore. We pulled a Carson Strong and we were kind of questioning who it was going to go to because he's not technically on a team and he never played for a team like in the regular season. I don't know if it goes to the Cardinals or the Eagles and Illegals, obviously an Eagles fan. He was in chat and he's like, Forrest was like, oh, I got to leave. Forrest was in chat too. David Bell, there's a Snoop Connor rated rookie to 25. Empty Box and Rapper coming to that one. That's brutal. Sorry, Jags. And Illegal was like, Forrest, where are you going? The fate of this Carson Strong card is games and the balance. He's like, who wants Carson Strong? I was thinking that was so funny. Jaylen Hertz, smart chase there, car. The one time I actually thought Illegal was pretty funny. I wasn't timing him out. Remember, Rad was breaking. I was stop loading. Sauce Cardner for the Jets, Mack Jones and Kishon. And Rad was breaking and Rad is like a big stranger things fan. He's like, anybody see like the first episode of Stranger Things and Illegal just goes 11 dice. He's like, and Rad had to time him out.  I can't be doing that, Rad. That was so funny. The fate of the Carson Strong card games and the balances. You remember that Illegal? I was like cracking up laughing, dude. And Rodgers to 50, 7 of 50. There's a James Winston, 72 out of 75. We've got a JJ Watt, 32 out of 50 for the Cardinals. We've got Roger McCreary, that is 7 out of 49 for the Titans. Nice one there at Tennessee. We've got back to back Titans hits as this is going to be a Eddie George, one of 10. Cool one there. Congrats, Tennessee. Eddie George, one of 10. Tennessee is Ken C. There you go, Ken. We've got an AJ Dillon, that is 2 out of 25 impeccable stars on Cardauto. Yeah, I was top loading that night. Yeah, I was top loading for Brad. Nice one here is Elegance. Jonathan Taylor, one of three on the laundry tag. Boom, that's going to the Colts. There you go, Indy. Nice one there, Jordan S. Congrats, buddy. Come back, then this one and the next one. Nasty JT, that's awesome. Back to back nights where I pulled, back to back breaks, like nights of breaking with this mixer that I pulled laundry tag to three of the running back. Pulled that CMC the other night. Oh, really? Yeah. Then we've got nice one here, Bailey Zappy, 17 of 25, three colored helmet, two colored gloves for the Patriots. There you go, New England. Roman S. Congrats, buddy. As well. Great end to that break right there, I have to say. Let's do a quick recap, everybody. I'll tell you there is another one on that illegal side. I'll tell you my favorite illegal moment of all time once we're doing the next, once this break's over. Quick recap, guys. We had the Jonathan Taylor and Marshall Fulk on the passing of the torch. Jersey King's two-colored patch auto is Kareem Hunt, Roger McCreary for the Titans, Eddie George for the Titans, E.J. Dillon for the Packers. Geez. One of three nasty laundry tag patch auto, Jonathan Taylor for the Colts and Dillon's getting the Zappy. There it is, 17 of 25, Bailey Zappy. That'll do it for the break, guys. Thanks again to the Phil. Next up, we've got what's it called, the last one of the


What's going on everybody got Kyle here with late sports cards, and we are rip it This is from Milan and it's gonna be five boxes tops chrome hobby and three boxes of tops chrome breakers delight. Good luck here Let's see what we got That's right, let's see some See some monsters here too some some rookie autos Good luck. Good luck tops chrome hobby. We'll start with the hobbies. We'll do the delight next. I'm in practice There's a Austin Riley. Let me actually let me get all these cards out. We'll go through them Be a bit quicker that way One football or something's even that's probably fine. Those are pretty quick. We're pretty close to probably already full But we could probably do a one those are quick Don't want to do that. It's about as quick as they come so down with that Carl Aftis All right guys again four stars at five o'clock got bowman's best today. He's got mixers bowman's best in sapphire He's got some bowman chrome you basketball All those gonna be doing the super fracter bounties again today guys got flawless collegiate Many insonite like I was saying with the 25 box Sunday Funday had few spots come in while we've been here today Keep getting those moving. We'll rip that one later 25 boxes some really nice boxes in there to 2018 NT 2020 NT Really really big boxes Some big names still in the playoffs as well to got Josh Allen Lamar Jackson in 2018 2020's got burrow Herbert to Hurt all right go through box one here.  Let's see a big auto. Let's see a super or red There's a Freddie Freeman refractor Blue is gonna be Brett Beatty on the rookie to 150 nice blue Beatty Mets on the rookie having Gossman refractor Hunter Brown Refractor Nate Eaton on the rookie refractor of Sandia. I'll contra McCarthy and nice one there is gay Moreno on the aqua lob at a $1.99 Good rookie catcher for the d-backs Fractor of Alec Bowe Prism Trevor story Luis Arias The Cossess rookie Josh young and our first autos to $1.99 aqua wave of Nate Eaton for the Royals aqua wave Bubba Thompson refractor rookie wave willy-a-domes Are you talking about the the debut patch Michael haven't seen it yet? Haven't seen a surface yet. I saw the other day someone pulled the The Bobby Miller 101 patch out of a blaster So I'm not sure if maybe someone hit it and hasn't said anything but there was a pretty big bounty So I'd imagine if if someone hit it you'd be seeing about it But haven't seen it yet.  I really really did want to pull one when we had some update Didn't ever hit one. I went in the Jordan Walker I think we're the two bigger ones who were chasing haven't seen come up yet. I think kodai sanga got full I haven't seen the Jordan Walker Evolpe though. Hey, what's up mark? How are we doing sir? How are we doing sir? You know the other day mark I went to the gas station got some chocolate milk and the Farm was from Edwardsville, Illinois It sure was Edwardsville, Illinois reppin in Orlando Historic Edwardsville Right good luck here. Malone. We'll get our second box go That guys do hit that like button Take me just reminding me if you guys are enjoying the stream I always do appreciate that guys helps us reach some new people. It's a little more exposure on YouTube You guys want to hit that like button always appreciate it guys are on twitch as well I can head over YouTube and hit the like button as well. I don't think there's a like button or anything in incomparable on twitch, but Appreciate you guys watching over there as well. You got Detroit and KC today. You might take a couple of ills I don't hate it mark. I don't hate it. I'm gonna I mean I like the I like the bucks today I gotta say those double L's, but that's just as a bucks fan. I would say there's a Prism Jordan Walker on the rookie Yeah, that's what I thought she has what I thought didn't think they had anything kind of similar There's an auto it's gonna be Michael Grove on the rookie. I don't see one ninety nine aqua wave Or the Dodgers Aqua wave refractor of Rafi JJ Blede on the refractor rookie Yeah, you could follow her. Yeah, I would appreciate you guys if you did follow us up either on twitch or on on YouTube Subscribe, there's a Alec Manoa And Titans to 99 that's gonna be a boba shit numbered on the Titans there What Toronto what is that tower called in Toronto again? No, I know Timmy's a Toronto guy Forget what that tower is called. There's Riley Green Think of it as the Drake Tower. It's called the Tristan Kossus rookie There's a Clayton Kershaw And CJ Abrams refracted for the Nationals Say ala Thomas features stars and gold is Cal Raleigh. It's a 50 the CN tower. Okay, I gotcha CN tower It's a 50 Cal Raleigh Here's Mark Toronto, that's right. That's right I'm down to visit Toronto. It'd be cool. Yeah, there's a Riley Green rookie I know Montreal's got some good food There's Ryan McMahon Be down for that as well a little Torah Canada. Oh, yeah, I'd be dead. Say, um, McKinsey Cora on the prism And a rookie Jonathan Aranda Apparently it stuck me on a when I was a kid I went to Alaska on a cruise and we went to Canada for like a day or two, but I was a kid I didn't care. I was like, oh That flight was long and then that's about that about it. Trey Turner there on the rookie Phillies Gunner Henderson rookie and Lemahue Should be Garrett Garrett golf tower. Oh man. Get out of here. Jared golf There's a Nolan Gorman on the rookie Insert refractor Trevor story. There's a base Adley Rochman on the rookie And green nice little color match there is Shay Langlears for the ace on the rookie Green on green there Jordan Walker base rookie refractor Toglia Here at Mitchell refractor and Gabe Moreno That's some good timing Jase the whole city of Detroit take off for uh, three o'clock here Is that what happened whole city of Detroit took off box three We did a lot of bass Really? Really? Really some bass up there. Oh, I'm all about that there in Toronto. Yeah. Hell, yeah Sounds like a good time. I'll be down Sean's always down to rip some bass yoke some pigs out of there. All right. Keep on moving here I was at the uh, were you calling us to the battle of alberta? Something like that. Come on bucks Come on bucks Yeah, I agree Jase because I'm here till 3 30. So I agree with that. I agree with that I would enjoy it in uh Little earlier or a little later. I should say a 4 30 like a normal start 4 4 30 Yeah, it might be Shane might be he's uh going into the season next year though I feel like people are going to be chasing him again. He'll get his uh, his hype will come back up Because Packers are pretty good man. They got a young receiving core. They could do good in the giraffe grab a few defensive players and Oh, I think they'll be right back where they are Right back where they are. Hey Larry Fitzgerald has the lines Let's see what Rex Ryan's thinking. Rex Ryan's thinking lines All righty here Keep on moving for you Milan Egy Rosario on the base rookie There's a refractor of adamis Willi adamis There's a wave not uh, Nolan aeronado Rocky's Ezekiel Tovar. No, he looks good. Yeah, he looks good. Uh, remars for sure There's a rookie refractor brian bayo. He can sling it man. He had he had some really nice throws even yesterday Um, there's a uh, jonathan aranda prism rookie Jared walles refractor and shintaro fujanami Yeah, he was slinging that thing yesterday remars. I would not I was a packers fan. I would definitely wouldn't be feeling bad about it Feeling pretty good about how he was playing machado there technicolor There's a josh young base rookie Miguel cabrera and a titans rookie of adley Adley rushman refractor rookie dermis garcia and wave is going to be a 75 that'll be vlad and jr Nice one there on the wave the home run derby champ Perez and one so-toe not a bad move shane not a bad move. That was a while back, right? I think I remember you telling me about Blowing up on some love. Oh, there's our guy It's a 499. We got riley green on the refractor rookie out of 499 go huskies Out of ovito Nice one there riley green to 499 on the refractor auto There's our guy got a jordan walker rookie jose abray you Prism is bragman Ryan nelson on the rookie refractor Any last-minute bets I should put in here? I don't know. I don't think I have anything going on Not like it better that way when the my team's playing Kind of like it better that way Could do the the old happiness hedge though and take the lines There's cow Mitchell refractor rookie Detroit kind of day. Oh boy You know, you're not wrong jace. You're not wrong There's a mj. Melendez and a negative spencer steer. Nice one. They're good rookie for the reds Spencer steer And a simian woods richardson prism from on marquez and mount castle on the back All right, mr. Milan three down box number four and we got some delight Get a quick box of masterwork for paul and then we'll end with mr. Jeffrey. You're not mr. germans. Tom Tom seat alex bragman the Logan web That's trevor store in the back because he has a weird like code written on all those cards From back he says All the trevor stories have that interesting. Well, let me battle them ours. I kind of like that idea. I like that idea Refractor rookie of Ethan small for the brewers Devers and cj. Let me open all these again. I forgot what I was doing I thought we were doing this The brand new lions. Let's go Let's go brand new bucks too. We got baker We got baker That's that dog in him Wolf wolf tj gj about to fill it up Joe knows about brand new. Joe knows about brand new football teams Playing playing completely different than they always do. He knows all about it his voice There's always some brand new jets. Yeah, I think Mike probably has a good game today Oh Mike Evans, I have to guess Our secondary's had some rough games this year. I'm gonna rock could uh Could go in Our secondary's had some rough ones this year. Yeah, an orange coming We have two oranges coming. We have two oranges coming potentially So I'm seeing that wrong Hey, is that gallon refractor? Shawn Layton gaming has labeled you as cable There's an orange waved at 25. It's going to be Nick Castellanos I don't know what that is Nick Castellanos He's a assassin I'm good. He's an assat. Josh Brolin played him. So Pretty close. Oh, okay. So in there Castellanos Shawn's boy 25 on the orange wave He's a low number there On the orange Hermes Garcia. There's a refractor John Gray Prism is Oscar Gonzalez rookie prism Ziko Tovar Rizzo There's a wave of Wilson Contreras Refractor Michael Massey rookie Bryce uh Bryce Hoppe Nolan Aronato Light cable There's a Jeremy Paine your future stars and Ian Hatt to uh 350 for the copies on the fuchsia Is it it kind of works it kind of works Brandon Lau There's Nick Castellanos on the prism Kyle Tucker and Otto this one's going to be a purple speckle out of the 299 Jack Larson with mariners Jack Larson Yeah, yeah, there's a prism. Um, Jose Miranda. Let's get laying gaming talking about you bro.  Jeremy Paine you on the back Alrighty Milan one more hobby the heck did I do that one more hobby put some respect in my name Good luck. Good luck Almost that time we showed that hot tub a bunch of times today they need to get out of there. They've been in there too long gross I'm gonna start uh start cooking I'm telling you just need to run up there and throw some celery and Carrots and potatoes in that thing Strive with the lasagna and the hot tub in the few weeks back. Yeah, the lasagna and the hot tub Uh No, I am filled up today, um Evan, but it would go later tonight It would go later tonight Um, I got a pretty big order coming up right after this one as well. So I am gonna be filled for tonight Yeah, we got sunday fun day tonight alan uh force will start at 5 p.m. Tonight. Uh same channel here. He'll start at 5 Um, he's got some bowman's bass baseball some bowman chrome. You um Some bowman chrome you basketball Some football and then he ends with um sunday fun day 25 box 25 box sunday fun day It'll be forest jake and jeff tonight alan that link is right below Forest jake and jeff chilling tonight. Make sure to break schedule Jake got here early I don't know Fair Yeah, sorry about that. Evan. We did call a little full. We're into three thirty. We'll probably go even a little past that um What we got ordered but Get that going tonight. I believe Later on tonight It did I saw that uh, Paul someone's asked me yesterday if we had any absolute on the shore and I was like Oh, we got this one then I saw it was already sold out yesterday.  What's going on? Better redemption story baker baker There's a asuel peraza on the refractor. He was written off by everybody Everybody there's a jordan walker rookie Future stars cj abrams So mccutche sh refractor. That was a crow Spencer steer on the uh prism What? Excuse me Oh, I remember you saying that the mini wings is okay. Okay breast to rank Sean had uh, Sean was a little upset about that. I remember that he did he did tell me about that reilly green uh, soto technicolor Yeah, you've heard at the mini wings The tiny wings ridiculous Yeah, I don't know what that's all about sometimes, uh Sometimes they just don't got it man. I've noticed that with wings recently. They're very very hit or miss and they're expensive There's a green sonar to 99. That's going to be joey manasis insert sam sonar noise No, john carlo and danzby fair enough jace Fair enough.  There's uh gunner henderson on the rookie And ryan malcastle 250 purple for the oaks Tristan casus Refractor of ester ruiz J rod every say hey forest Yeah, it was cold earlier. So we never turned the fan Yeah, I would have still turned it on warmed up. I would have that fan on higher probably. Yeah No, there's an auto uh brewer heckling rookie out of there for the royals There's sam. There's the sonar noise. I was So hoping we would hear there's a carlos korea.  Yeah, he was he seemed pretty happy It's masatake yoshida on the rookie Past a uh tani there for you First one is the ones he doesn't relieve Bye back to tani there Yoshida Yeah, that game uh that game was good in the first half and then it took over future stars hunter green And that'll do it for you mr. Malan That'll do it for you on the hobby.  We'll get tom um done though. Um And steven. We'll do one box. He has a one football. We can do that real quick Do that real quick Right good luck here. Malan Yeah, yeah, I told ebb and he would uh be first up He's got some uh moments best you Case case of it Righty. Good luck here. Malan. We have refractor tim anderson Rookie of kanan smith and let's go box three down. All right. Three down already. Yeah Let's go let's go jc romuto refract Got uh tyler freeman rookie. He's actually killing it man. Jerry goff couldn't see it. Yeah lu castillo and sonar we wu to 99 is jt romuto And sonar we wu to 99 right behind its green of any past casino We will It was uh, he typed it out. Let me see. Let me see. I'll try to read it. Yeah typing isn't good. Uh, we wu we wu we wu Sonar, yeah, it's what he said. Sam did talk to text like the We wu sonar Got a gold of 50 jj bladay youth quake And there we go malan to 250 on the rookie auto anthony vulpe Okay, that's pretty so my man for the yankees will mag that sir That is a good hit had a riley green as well hitting our boys here Nice vulpe purple. That's 250. Did you guys take the uh tray palmer pissed off any time touchdown?  So well benzin and uh youth quake of wander youth quake Hmm box two Uh delight I'm sure baker woke up feeling dangerous by five bowls though hitting the road. Hey, we'll see you chase We'll see you a little later my man I'm sure I'm sure you'll be back That's right paul fire the cannons. That's right. That's right paul Got a leo peguero refractor rookie jonathan india. There's crawford and trevor story Here we go with shon cj abrams and ryan mcman The cannons going fire cannons go cannons. Yes There's a 399 louise orteez on the fuchsia rookie for the pirates and cal steven send a 299 Jake are you ready to be the qb for the bucks?  That's oh, that's true Yeah, but like I mean a lot of guys don't move, you know Let's have a qb, dude refractor lu castillo and there's a negative mini diamond auto of jeter downs for boston Jeter downs jaker that's that's breaker may feel right there. Not Let's go. Let's go Get out of the way my kevin. Yeah money kills are on on the refractor and He did blonde Let's go box three uh breakers delight Oh, man.  It is jaker was jumping there. Let's go All right, last one here malon. Good luck. Good luck again guys. We'll probably go a little after 3 30 And get uh, mr. Tom done and then one box for steven. We'll get going Right into it Got a dillon. All right. It's max free max free um, erin judge jd j ram jock peterson and cow rolly refractors All base refractors there. We have this 75 a rookie outman on the wave. Nice one there dodges Green to 99 a wand soto Yeah, just run the whole whole drive. Don't get a bigger and third one. That's one day. That's when bad things happen 299 is wilson kontreras. Yeah for the for the defense Oh, oh, yeah, okay Base rookie freddy firman And on the back we have a jona brides of 499 refractor rookie for the ace Uh Should have though it's cold outside rookie youth quake is riley green And that will do it that will do it malon eight boxes there of tops chrome and five hobby and three breakers delight Thank you so much my man. We'll get those right out. See a nice volpe there at the end get those right out to you sir


His rookie season when he got the Friar haircut, like can you tell us the story behind that? See that's what's funny man. I wasn't the guy that's gonna go gather up the rookies and cut the hair, but I wasn't gonna stop it either. And I always wonder what are they gonna do to Tibo? Because there's always some D-Lime in the linebackers. They're gonna just go all in to get that haircut. I think that's where it really let us embrace him is he knows he's a popular figure. Probably the most popular guy in the league and hadn't played a snap, but yet and still he would reduce himself to these rookie challenges and this rookie hazing, so to speak. So I love that about him. He was definitely wanting to be one of the guys.


Okay, hi everyone. I'm Derek Slobo and this is a prosthetic arm project so From here from these statistics you can see that there's clearly a demand for prosthetic arms, but the thing is the the cost But the cost of prosthetic limbs is pretty much absurd can anyone here guess what is the rough range of prices? for prosthetic arm any guesses Okay, who thinks it's in the hundreds range thousand 10,000 10,000 20,000 30 40 all the way to 100,000 Well, this is the actual cost So roughly for me electric prosthetic arm it can go around 30 to $100,000 especially for functional one and Daffa has recently developed a mind control prosthetic arm that costs about $100,000 but was developed at 100 million that has clearly Too much for a normal person to afford and usually the people who affected most are people who do labor or non-skilled Jobs that require them to be able to use their arms and legs So first I'm just going to go through some introductory policy on how the arm so I can explain how the arm works so basically When you think of something or you want to do something your brain uses electrical messages to communicate with your body, right? So the question is how can we intercept your signals? How can we detect them and how can we interpret them? so If you can see here, this is a sign up. So basically your transmitters go across the sign up in order to carry information So I'll explain why this is important later for the scary on first so the first method of Viewing these electrical signals is electroencephalography So basically we are we are trying to understand the brain waves by measuring electrical signals and using a Fourier transform we are Converting them to a sinusoidal input So with that we can understand how the brain works and how information is carried So we are using a machine learning software to basically understand its signals and use it to control Servos or soft robotic arm or whatever we need So let's say I were to let's say I want to do this Basically, my brain will send a certain signal and if I can measure the signals in the motor cortex using EG I can sort of understand what the brain is trying to send The second one, which is much more accurate is electro myography, which is basically a measuring electrical inputs Electrical signals in the muscles. So this is currently one of the methods I'm using and this is actually the device that I'm using It's called a meal band, which is also used by DARPA So basically the I use the electroencephalogram and electro migra, which interfaces with an Arduino microcontroller and basically that sends a serial information on Basically the electrical signals, which is processed by the meal greener software, which was not made by me And coupled with the machine learning software It basically Analyzes the signal and tries to figure out what you're trying to do and with that I'm using two types of Prosthetic arms one is a soft robotic arm and one is mechanical arm So using that I use it to control the arms So most prosthetic arms don't have sensory feedback So you don't know how much pressure you're using to hold an object You the arm doesn't know whether you're holding an egg or a glass or metal weight So you doesn't know how much force to use Also, if you bang your arm on the wall or you damage it in some sort of way, you have no idea What's going on and it also doesn't feel natural and And you can also a lot of people that amputees they experience something called phantom limb pain Which is basically since there's no input The body feels that there's something wrong because there's no information going where the arm used to be So we can solve this by stimulating the brain So then multiple methods of doing this I go for the traditional non-invasive method So over here, this is the somatic sensory cortex which is basically the part that controls motor function and allows you to feel so I'm trying to stimulate summary around 3A to 3B in order to evoke a tactile sensation in your fingers So there are multiple ways so now I'm going to get back to the sign-ups So basically how electrical signals travel across the sign-ups is When there's enough action potential Neurotransmitters go across the Across the membrane to complete the gap and that's send electrical signal However with ultrasonic neural modulation, you're basically vibrating the cells at a particular frequency that increases the permeability Allowing more neurotransmitters to go across therefore you can artificially elicit sensation by stimulating the Synapses using ultrasonic neural model modulation Another thing is trans-cranial magnetic stimulation So because in your neurons you have ion channels and your ions that flow throughout the cell which allows you to have Action potentials and allows electrical signals to be involved So using trans-cranial magnetic stimulation We're actually inducing a current within the neuron to elicit sensation Now there are two other methods these are quite simple Anyone can try this at home One is ultrasonic nerve stimulation and other is direct electrical stimulation So ultrasonic stimulation works the same way as trans-cranial ultrasonic simulation It's basically you vibrate the synapses in your nerves Therefore allowing an action potential to occur so you actually feel a saturation Same thing for electrical nerve stimulation. This you're directly inducing current within the cells So now I'm going to talk about the difference between a soft robotic versus a mechanical arm so When you think of soft robotics you can think more of actuators and pneumatic cylinders things like that Which use air and fluids in order to create motion something like how a squid moves Versus a treasure some mechanical arm, which is used as servers wires like motors things like that So soft robotics can actually store energy like because they are they're soft and renewable They can bend they can they can basically they can they have much wider range of motion with the with the same cost range So but some problems are soft robotics are hard to model So basically how you want it to move and all it's quite difficult But they are much cheaper because servos and things like that are really different expensive especially with our arm you need multiple degrees of motion and then multiple fingers and Ways that you can move each finger and if you just try yourself you can probably move your finger all around So if I were to do that with servos, it would be much more expensive. That would make me at least five six servos both finger So did it work? Well sort of so here you can see on top. I made a soft robotic glove. So basically this I have fluids that go to the reservoir which allows me to maneuver the arm and On the bottom is the mechanical arm So you can see the rest the Raspberry Pi and Arduino within the inner part of it that Controls arm. So the second one has a servo motors and all that is just a prototype so Over here. This is the signal generator and amplifier that I'm using as the amplifier. I'm using to Do the ultrasonic stimulation because for the transducers you need a really high voltage and This is actually a part of a Neurosky EEG headset that I modified in order to use for my experiments and This was the first prototype. So you can see how the how the arm works this mechanical arm So basically the servo motor here pulls the strings which allows you to move the arm and because the The strings is acts like a spring. It stores energy the finger snap back Once you serve So there are multiple different Applications of the technology that I mentioned So basically if you could stimulate the brain there's lots of There's lots of possibilities that you can do you can cure depression you can help people with problems who can't who have for example people who have cerebral atrophy and they can't really Control their body because their brains are sending wrong signals. So you can intercept these signals and you can generate your own so What's the future of the project? Well, since it's all open source, I'm releasing everything online on jib hub and other platforms So anyone can continue the project and try it out at home for themselves or there are not lots of non-profits like engineering goods that I'll be talking to you see if they want to try to implement it Because right now we are quite close. We can actually create a prototype that someone could use and especially for the price range So the arm here currently costs about five hundred dollars If you could buy everything brand new but because I got all the parts second hand and Some of the parts I wired together myself. I managed to get for about hundred dollars Hundred to two hundred dollars, which is really affordable So you can follow the project here on jib hub This is my email if you're interested in contacting me to find out more about the project So you can also see I've also some I'm going to post some pictures on Instagram also so you can have a look there Are there any questions? Do you mean replicate a simplified model or Oh Something that we can you can do it at home. Yeah, okay, so if you need to get Okay, so if you're just doing it at home, and you're not really making a prototype You can use things that you have a home like you can use your laptop instead of raspberry pi for an interface And you can you you just need out, you know like I can show you the This was the original original project at science hack day. So this is We're just trying to get whatever Things we had at home and try to build it in one day. So this is actually some guitar strings Popsicle sticks a few nuts and bolts and It's just mounted on a normal plywood board and I just I'm just using Arduino at the moment I'm one servo motor and that's enough to give you normal contraction now You also need a eG device or EMG so if you can use the meal ban Which you can probably purchase for what $50 secondhand or you can try to build your own But that's a bit difficult if you're doing at home It's the meal band and while if you're interested in having a look you can also use it to control your computer Do other things with it? So did I answer your question? Okay, I Mean For the one the current prototype I have 12 servos Yeah, I'm using a motor controller But Yeah That is you you can do that So the different ways so sometimes they utilize like a socket So you just put the so you put your the stump of your arm into the socket and you can Strap it on but there's some more advanced ones like the DARPA project, which I have a picture right here Where you can see it? Okay, it's hold on one more. It's gone for some reason Yeah, so you can see the arm is actually physically joined to his own So it's like an extension of his actual arm So that really depends where also matters on your price range because this arm here costs about hundred thousand dollars Any other questions Yeah, why not it's just the part that you need to view is just a different area of the cortex Yes Yeah, exactly Normally you use the MRI and how to find the correct area and it also depends on your budget Because he is accurate But the most accurate will be ecog which is implanted where they put electrodes directly on the brain But that is expensive and I can't do that at home. So Also for leg you you won't really need such precision. You could just have a motor controller with the leg that Basically moves when data move leg moves. So basically when you move your torso the body the leg just follows You don't need to actually interpret signals from the brain for that but because the arm is very complex and you have multiple kinds of movements that you can do you right you need that Means Yeah, I guess in that sense, yeah, but it's also Fit doing the fittings and everything also the leg is much bigger So it's difficult in that sense mechanical sense, but not really an interpret signals So you won't really to tap into the brain Anything else? Okay, so you see for so basically when when he wants to move his arm His body sends signals through the motor nerves that goes through the arm right and over here you can see these two sensors So basically each one is a channel EMG device So that measures the electrical signals in the arm and basically that tells the robotic arm what to do anything else Oh Yeah, that's what I meant by the sensory feedback So when you act when you touch something you will actually feel it even though it's a robotic arm Because the signals are sent back into the brain because you're stimulating the somatosensory cortex Yeah Not to the mule band but through the Yeah Through the magnetic stimulation Transparenia magnetic simulation where you induce the current within the brain because all your signals in your brain move through nuance Right if you were to create a signal within the brain an artificial signal it would perceive it as feeling and Because it's because of the shape of the coil you can actually focus the magnetic field in a very Close area so basically you can simulate each individual So it can either be held above but that's really impractical Most likely it will be implanted or you could have a really a flat version that you could stick on the scalp For my arm or for So mine only has one degree of rotation which is in the wrist Because otherwise there's you need too many servos and too many things but the soft robotic arm has much more degrees of motion This is for my arm it's I'm assuming the person is amputated at the forearm so I didn't build this part on Yeah, yeah, you can and that's that's also the reason for the sensory feedback Right because if you were to hold a stone you could feel the texture versus an egg Right, and also you know how much pressure to put if let's say I'm I'm if let's say I don't I can't feel anything I don't know how hard I'm gripping something But if I can feel it I know exactly how much force I'm using so with the sensory feedback Basically when the arm grabs something I have that you can use touch sensors that can feel the amount of force That communicates it back to the brain Yeah Give the wrong signal to the brain and Cause some like it feels like nothing happened, but person may feel like it's a lot of pain Okay, so you mean if you stimulate the wrong area. Yeah. Yeah, that that is a Yeah, that could you could cause a lot of problems if you stimulate the wrong area because ski for example KMS is also used to treat depression Basically, if you can stimulate the brain right the brain is extremely complex if you don't focus it correctly You can cause a lot of damage one being Seizures if you create a close loop sensation you can create the scissors So basically you have to you have to be careful in that sense and you don't you don't build this yourself and just try it at home So this a professional will align it and everything and ensure that it's working properly


Have you noticed that rich people behave in the same manner when it comes to certain subjects, like that of money, while poor people tend to think and act in a way that is different from the rich folks? Could it be that money makes people think differently, or perhaps, people who think differently from the nom, tend to make more money and become rich at the end of the day? According to T. Harv Ecker, the author of Secrets of the Millennial Mind, rich people believe, I create my life. Poor people believe, life happens to me. Now that's a major difference between both parties. Rich people see themselves as being in charge, hence they take responsibility for their lives and determine what they want to become of their lives. Poor people, on the other hand, do not understand this. Hence, they just live life the best way they know how to live. In the end, they end up creating some terrible daily habits for themselves. These habits become responsible for the state of their financial freedom. Remember, our habits form us. Aristotel said, we are what we repeatedly do. Excellence then is not an act, but a habit. In this video, I'll share with you 10 things only poor people do. This, I believe, will help you become a successful person. If you're new here, consider subscribing so that you won't miss other interesting videos like this. Poor people believe money is evil. The beginning of the problem for poor people is that they think money is bad. As a result, most people dislike rich people because they think that they are wicked. Money is a tool that can be used for both good and bad. People who, however, see money as being bad are lazy people who are scared of chasing their dreams. Hence they justify their actions by saying they do not want excess money because they do not want to become bad people, forgetting that money can be used to do great stuff. You see, if you truly believe in good things, helping people is a part of it, and you cannot do this if you don't have money.  2. Poor people blame others. Poor people think that they are poor because their parents were poor, or they grew up in a poor environment, or they had no money to go to school, and so on. They think circumstances or people are responsible for their poverty. They fail to understand that everyone is in charge of their lives, and can make it whatever they please to. Check out one or two rich people around you. Do you notice how responsible they are? Not only are they responsible for themselves, but others as well. Poor people, on the other hand, prefer to shift all their responsibilities on someone else, and they never blame themselves for their mistakes. Instead, they find a way to blame the one who is responsible for them. 3. Poor people spend their time watching television, while rich people read. According to Zig Ziglar, rich people have small TVs and big libraries, and poor people have small libraries and big TVs. Poor people find pleasure in getting entertained, which is why they'll sit in front of a screen all day long, watching reality shows to find out what's going on in other people's lives, or spend all their time surfing the internet and getting entertained on social media. Instead of spending their time investing in self-development, they'd rather enjoy several hours of entertainment on TV, which is why they remain poor. 4. Poor people prefer to get paid based on time, while rich people on money. Poor people are not result-orientated at all. They want to come to work five days a week, four weeks a month, and then get paid for their regularity at work, whether or not they get their daily tax completed. Rich people, on the other hand, prefer to be paid based on the results they achieve at the end of the day. So, if it means taking a longer time than normal to achieve an excellent result, they'll go for it and get paid accordingly. Little wonder, David Bailey said, to get rich, you have to be making money while you're asleep. 5. Poor people think they know it all.  They always seem to know it without expertise. Poor people think they know how best to make money. They think that they are smart and strong enough to make money by working harder to earn more money. While rich people keep learning, growing, and stepping out over their boundaries in search for self-development, poor people tend to be opinionated about anything that is outside their realm of influence. They have an opinion on almost all subject matter. They think they know it all. 6. Poor people focus on saving while rich people on investment. Saving is good, for saving without an intention is a poor decision because you'll end up spending the money on things that don't matter. T. Harf Ecker of Secrets of a Millionaire said, if you're saving your money for a rainy day, what are you going to get? Rainy days. Stop doing that. Instead of saving for a rainy day, focus on saving for a joyous day or for the day you win your financial freedom. Rich people save towards investment, poor people towards rainy days. 7. Poor people always have an excuse for why they have not made it. Ask someone poor why he hasn't made it yet and then listen to what he has to say.  They want people to empathize with them when they are done listening to their excuses. They think they have suffered enough and deserve to be helped, hence they keep sharing the same old story of they had no money or opportunity to get a qualification and the likes. Poor people always have a story to tell why they are not rich. Rich people, on the other hand, accept everything that has happened to them as an opportunity to become or remain successful. 8. Poor people surround themselves with poor people. E. A. Buckinary said, evil influences like a nicotine patch. It cannot help but absorb what sticks to you. Also according to Michael Bassie Johnson, to be of good quality, you have to excuse yourself from the presence of shallow and color-minded individuals. The truth is that you can expect to be around poor people and become the superhero rich friend in their midst. It doesn't work that way.  Remember, ideas rule the world. But when you have nothing relevant to offer, how then can you become rich? 9. Poor people complain about every problem. They never find a solution. The government is bad, the roads are terrible and the world is such a big problem these days. You know what? I am sick and tired of it all. Why can't somebody just get it right for once? Do those words sound familiar? They are the words of the poor. They are full-time complainers. For example, most poor people who get in an accident spend the next three days talking about the accident, what happened, how it happened and so on. On the other hand, successful people will immediately call their insurance company, settle an appointment to fix their car at a shop and be done with it. Rather than dwelling on what has happened that you can't change, why not focus on finding a solution to it moving away from it in good time? 10. Poor people only think of how to make money, not how to be great. Mark my words, I'll be a millionaire one day or I will own a Lambo one day. I'm sure by now you know where those words come from. Yes, from poor people. Making money is the ultimate for them. They don't think of how to become great. They are only interested in the things they can begin to buy once they start making money. When you go ahead to ask them how they intend to make money to buy these things, they have pointed out, they say things like, I'll own my own business, build a brand and so on. People who focus on being great think about how they can become one of the best guys in their industries. They have goals like, I want to become the best car salesman or become the number one restaurant in the city. When you become good at what you do, you'll definitely become rich. Thank you so much for watching our videos. Do you love to start your day with high energy? Then we invite you to join our new channel which was designed to give you daily inspirational videos that will help you become a high achiever. We call it Inspiration Tube. Look at the description box to join the Inspiration Tube. We love you.


While staying with education martyrs, it makes determined quests towards reducing the increasing number of out-of-school children. A group has expressed readiness to provide financial assistance to no fewer than 10,000 out-of-school children. The founder, Ebu Oluwajibari, who made this known at unveiling of the Delight of Christ Rescue Home, also revealed plans to build a facility that will provide free education at the necessary primary and secondary levels. Oluwajibari stressed that the search in out-of-school children remained a global threat that needed to be tackled by groups and while spirited individuals. She explained that the body would provide fully funded scholarships covering the three major levels of education to the less privileged. Please, help our populous schools. Populous schools is getting out of hand, that's that. Populous schools increase the normal populous schools that we have. So this children that they pivot could not have all the money to help our populous schools, could actually be able to benefit from the populous schools. Personally, I went to populous school when I was growing up. So populous schools nowadays, sincerely and most confess, meet much more supports of the government. And of course, this NGO is meant to support the government in their own little way with these children that are running about the streets.