Energy reboot is a spiritual practice that I do multiple times a day. In fact, every hour that I work, I do the energy reboot at least several times. It has made a profound and positive difference in my level of joyful productivity over the years. So what I'm going to do is to first show you the exercise, and then I will explain each part of it. The first thing I do is to place my hands on my heart. And essentially we're going to do several deep and gentle breaths together. So if you'd like to follow along, hands on the heart, breathe in, breathe out. And think, thank you for having brought me here through all the ups and downs. Thank you so much. And keep breathing, of course, as I go along, we don't have to do the exact same number of breaths. All right, now hands to the stomach or where I can feel my breath going in and out. If I breathe deeply, hands on the stomach, breathe in gently and out. Thank you that you will bring me through everything, all the ups and downs coming up. You will bring me all the way home. Thank you. Now what I do is place my arms to my side in an open, receiving posture as you'll see in the video that basically replaced my hands open out like this. Deep breaths. Thank you for the healing. Thank you for the support. Now I bring my arms all the way up above my head and do a big nice stretch upward. Thank you for this moment of practice and arms down back down gently to the side and for giving me everything that I need for this moment of practice. That's it. When I'm actually doing it multiple times an hour. It only takes about 30 seconds each time. And that is really important because the practice is so quick to do. I am much more likely to do it often. And it's by doing such a practice so often throughout the day that my life changes. So if we are really committed to a higher quality of living and working, then we can't afford not to do a practice like this throughout the day. I know that some people enjoy meditating or praying or journaling once or twice a day, maybe in the morning and then the evening. And that is a wonderful kind of more intensive practice. What I have found the most life changing truly changing the way I bring the kind of spirit and attitude that I bring to every hour of work to be able to get unstuck at a moment's notice to be able to do the hard things and not procrastinate. How do I do any of that. It's by doing my energy reboot practice at the beginning of each work session and several more times during the work session the only exception is when I'm in a meeting. Then I don't do my energy reboot but I still am aware of my breathing sometimes throughout the meeting I'll be aware and as I exhale I'll be exhaling. You know, with a thought of gratitude or the thought of support something or thought of healing something like that. So this energy reboot I've been doing since gosh it's been at least five years and I've done this every single day multiple times a day. You may have watched another video of mine from several years ago. When I taught the first version of the energy reboot, and I did that first version for several years. This what I've just shown you is the second version of the energy reboot and I've been doing the second version consistently for about six months and it's one that I really enjoy now. If you haven't yet tried the first version that is actually a really good place to start. You can try both versions and see what you resonate with. But for, you know, whatever reason that first version was really important for me to do several years first. And then now I'm doing the second version and it's, and it's, I feel like it's a nice follow on to that so let me explain what I just did, and sort of the philosophy behind it. So first of all, the fact that we are deeply breathing is some and I'm consciously deeply breathing several times an hour is more than most people. I think a lot of people grew through their days without being aware that they are breathing in a very shallow way, and not breathing deeply is not good for the brain. It's not good for your energy, essentially, both physically and emotionally, mentally, and you might even say spiritually. So even the simple practice of deep breathing which both versions of the energy reboot had deep breathing is just going to be helpful, period, even if you don't add any movements or thoughts to it. But then I think the movements and the thoughts bring additional power to this practice so as you as you saw the movements that we're doing, it kind of reminds me of what the what the segments of the energy reboot are you know hands to heart feel the heart beat hands to the belly feel the breathing posture of receiving hands on the side, stretching also of course is good for your physical energy and your flexibility and just, you know, staying healthy and balanced.  So it's just, even if we look at on a physical level, this energy reboot it's just a healthy balancing practice to do several times an hour like I said, it's how frequently I do it that has changed my life it's not the fact. The energy the practice itself may be powerful, but it's actually quite subtle, but it's the repetition of doing it dozens of times every day that made that has made me a different person today. It has like physical, I feel it's both physiologically changed me but also mentally emotionally and spiritually changed me into a much more productive, joyfully productive person. Those are the physical reasons why we do those things now let me describe the thoughts that go into each breath. So when I said thank you for having brought me here. I am thinking about God and now you can, some of you may really resonate with the word God some of you may be turned off by the word God. Just use another word source, universe, life, higher self consciousness, spirit guide, support team, however you want to use, choose a word that that feels really good to you that you feel is a real spiritual support and use that word or phrase. When I, you know when you think about thank you or thank God or whatever so I, I say thank you for having brought me here. This is, if you look at your life right now. It's a miracle. You have been through so much in your life. All the, perhaps some trauma. All kinds of different kinds of trauma major and minor. All these challenges, unexpected situations that have changed your life, put it in a different direction. You've been brought through it all. That's the fact you are here now. And isn't that a lot to be grateful for that you have been brought here to this moment now through all the ups and downs. Right. And what the first breath is about it's just an acknowledgement and I really when I take that first breath of gratitude. I really try to feel sometimes almost tearfully that I have been brought here to this moment through all the challenges through everything. You know that just like, it's almost like, and because I do this practice so often, like I said dozens of dozens of times a day right just every hour, three to five times. It's like a difficult project when I'm facing a difficult thing that I don't want to be doing. I, I sometimes do the energy reboot every five to 10 minutes. I really do I do it as often as I need to, because it takes 30 seconds and it immediately shifts me into the mindset of gratitude and possibility and strength and love. You've been brought here. It's like when I when I give that when I give thanks for having been brought here I often sometimes say why sometimes say, you see God, you've brought me here again. I mean you've brought me through again, again, again. It's like constantly reminder like, look, I've been brought through yet again. This week, you know, a couple days ago was very challenging day, but yet right now, I've been brought through yet again. Isn't that amazing it's a miracle. And it's like almost proving to myself. It's, it strengthens my faith that see God, God has brought me through yet again, yet again, yet again. And that repetition is very strengthening to my faith. And then the second breath that thank you that you will bring me through all of it. Right just like God has brought me through to this very moment.  I'm all going to be fine. I'm going to be brought through all of it, all the way home. So it's a statement of trust and faith gratitude security, complete utter security there's nothing to fear because I will be brought through, and you will be brought through, you will be brought through all the ups and downs you will absolutely make it all the way through. Nothing at all to fear. And then the third breath, and the third gesture, third thought is thank you for the healing and support. And at this moment, I am imagining my spirit guide putting there. I don't know if it's male or female. I'm not that I'm not that spiritually aware and sensitive, but I imagine my spiritual support team I actually I literally believe this now I don't know what you believe. I don't know what you believe below if you would like, but I literally believe there's a spiritual support team right around me that I can't see they're invisible right now. But I imagine that they're they're all putting their, you know, kind of like they're they're reassuring kind hands on my shoulders like everyone together like they're putting their hands on my shoulders with for that third gesture. And I just think them for healing my entire body through and through. If there's a particular physical challenge I'm going through at the moment, maybe it's my eyes or my ears or my heart or my lungs or whatever I'm feeling that needs extra healing my brain whatever it may be. I thank them for the healing of the third breath I'll particularly thank them for healing that part of my body so literally isn't it's amazing and ever since I've been doing the second version of energy reboot I haven't gotten sick. It's been at least six months. And I used to get sick a lot actually. Well, ever since I started doing energy reboot I did get I've gotten sick less and less over time but especially the last six months I've been I've been very healthy. And I don't know, I think it has something to do with it, feeling healing energy, dozens of times a day, even first for one second, I think makes a difference. Who knows, it doesn't hurt. And by the way, when I read out and feel the healing energy. I practice this so much that I can simulate the feeling of tingles shivers and the goosebumps for like half a second. When I feel it and imagine it, and I don't know if the shivers and goosebumps I'm probably manufacturing that with my mind. You know because I can feel that now, but I'm just imagining I'm using faith. That's what faith is its imagination. That's my direction. That's what I define faith as its imagination in a helpful positive direction. Right so I'm using my powers and imagination that connecting my shivers to the physical healing that's happening so that's my third breath. I thank them for the healing sometimes I thank them for the support and the kindness that they are so hard working can you imagine your, your spiritual guides my spiritual team. They are so hard working they're working like 24 seven they like never rest and I guess they don't have to rest. I don't know maybe they do rest I don't know. They're so hard working like all the time they're on the job is I can always call out to them, you know and you can too with your spiritual team right.  And I think I thank God for this moment of practice. And what do I mean what I mean by that every moment of work and life is a moment of practice. I call it a training moment. I believe the purpose of life I know that's very nuanced and complex topic but I believe the purpose of life is growth. A purpose life is simultaneously growth, as well as acceptance of the profound love that's with us at all times. It's like, it's like that dance between between the yin and the yang it's like, in the acceptance and receiving of the unconditionally amazing. If you only knew you would break down in tears on the floor in a puddle forever kind of love at the inside and the yang side of purpose is growth and courage and virtue and learning and, you know, expanding our consciousness and all that stuff so I think it's both but, but I think I thank God when I stretch for this moment of practice, this is a moment of practicing growth, or practicing receiving whatever I need in that moment, but some moment of practice, practicing 1% better for this task that I'm doing. You know, the different ways I think about practice so that's the fourth breath and then finally the first breath as I bring my arms down is to thank God for giving me everything I need for this moment of practice there is nothing that I'm called to do this hour, this next 20 minutes this next five minutes that I have not been given the resource to do. So everything, that's why I don't procrastinate. You know, not anymore, whatever hard thing I do, I show up I do my energy reboot and I know that even if it's hard, even if it's confusing, even though I don't know what it's going to turn into. Even what I need to in this moment to move it forward just whatever I can do in that moment so I hope this is helpful. If you, you know, want to modify this practice. Please feel free. It's not copyrighted. It's not patented. It's just something that helps me. And maybe parts of it will help you too. So please do feel free to modify the words that are said the gestures that are done. How many breaths you're taking how you're taking those breaths but really the key is breaths and thought aligned for about 30 seconds, multiple times an hour. This is again I will end with this. It is so important that you're not just meditating once or twice a day that you're meditating. So, so I work, what seven, eight hours a day seven, maybe like seven hours a day so seven times, at least three times an hour that I do. So I do this energy reboot at least 21. That's not true because I'm in some meetings on some but but in the when I'm when I'm working. So not all seven hours are by myself sometimes I'm in meetings. So let's say I'm working by myself for about four to five hours a day. So now about at least a does four times three. So I do this energy reboot at least three times an hour usually ends up being more like five, six times an hour. So let's say an averaging for four times so I do this energy at least 16 times a day. At least 16 times a day. So what about you how often do you do your 30 seconds spiritual practice because if you're not doing it that frequently. I wonder you feel lethargic about procrastinating feeling stuck feeling anxious. I'm not downplaying those things but I'm saying that you don't have to it's always a choice, whether you want to keep feeling procrastinating anxious resisting something that's going to move your business forward. You know it's like there's nothing you can't do. If you just take it step by step, and if you just spend enough time doing it. That's it. That's like the path of success is just to take everything step by step to spend enough time doing stuff, useful important things that usually you want to procrastinate on, because it's not the definition of a purposeful and growth activity is something that done excellently before.  But if you do this kind of energy reboot or whatever it is that you do you won't be afraid of failure or at least you won't let it get you stuck, you just keep moving because you know that whatever it is, you'll always be taken care of. That's the key for me anyway that's that's how I can keep moving forward in my business year after year after year, you see me show up time after time. It's not a hamster wheel. It's not because this energy reboot helps me bring joy and grace and love and beauty to every hour of work, because I'm it's just an hour of practice. It's an hour of practice connecting to God source higher self consciousness, pick your term. It's an hour of practice in connecting to God and bringing more a little bit more of Godness, sourcedness consciousness into the third dimensional reality that we're all participating in here. So it's just bringing a little bit more heaven to earth 16 times a day. And therefore, not surprisingly my life is like heaven today. I really am grateful I was like I don't need to go to heaven this is heaven. This my life is amazing. Right, I get to do have a great business I have amazing clients and students and friends I mean it's, it's astounding I have tapped my creativity I know how to tap my creativity on demand now because it's not it's being able to overcome procrastination at any moment I mean that's true power. Right. And that's that's heaven heaven is true authentic power that you can call forth and a moment's notice to create to to love to help to serve to grow. So I hope this is helpful. And let me know if you modify this practice and let me know what modification you bring to it below because others who are watching this maybe may find it helpful. But most importantly, go and practice the 16 times, or more per day, and it will change your life over the next few years.  All right, I wish you well. My name is George cow. That's Kao. And I love talking about how do we essentially bring heaven into our business more and more day by day. So, go and do the practice, whatever practice works for you like this. And I wish you well.


Sheber 1000 here. Today we got a couple things to do on this old Chevy Suburban here. It's got well over 200,000 miles on it. It's my nieces. We've done some work on it here before.  But this is a little different. She's got a noise in the front end. So this is 2003-2004. It's seventh month of 2003. So I believe that would be a 2004. But right in that area, if you got one of these, it'll pertain to you. So let's see what this noise is. She's talking about. She went and bought brake pads for the front and back. So let's see what's going on with it. Okay guys, now I got she's even in quite a bit here, but I jacked this up before I started the video and when I did, the wheel kind of went like that. So I was thinking, well, it must be a bad ball joint. But look at it. That wheel's not loose, but something is right. I think it's the wheel bearing. Let's curl under here and I'll show you why. Okay guys, now I didn't bring my light out. I forgot it. So hopefully you can see right in there is the wheel bearings. This is set up for, in case you have a four-wheel drive, which she doesn't know. That one over there in the center of it, right about in that area, there's a black cap on there. But if you look at this, let me turn it. There we go. So and if you can see that right down there that blue, that means it's been hot. So yeah, she's gonna need a wheel bearing. So she's got new brakes and rotors. I am gonna put, yeah, she wants the oil change too. She's complaining she's going through a little bit of vena-freeze once in a while, but she's never noticed any leak. And it's not smoking out the back, so I'm not sure about that. But anyway, that's what she's looking at on this side. Of course we're not going to replace these right now because that all has to come off to, she's gonna need one of these absolutely positively for sure. So and she lives about a mile away from here, or not a mile away, an hour and something away from here. So that's her noise. Yeah. Alright, let me, let's go ahead and pull the wheel off and I'm gonna go ahead and check on some, see kind of what that costs for her. So alright, I'll be back with you guys. Hang loose. Get it? Loose.  First thing I want to do is I want to unplug the ABS sensor. It's right here. It's up above the shock there. I've got to name it. It's right up, right up underneath there. I'll show you since you didn't get to see it. It's up, damn it. It's up behind here. So we're gonna unplug that. Just like that. We're gonna take this clip off of here. In fact, I'm just gonna pull it out for now. Maybe. Anyway, you get the idea.  So I'm just going to take a C clamp and I'm gonna push this all the way in. Now this is a dull piston. It's got two pistons in it instead of just the one. So now sometimes it'll get both of them if you just do one. But I like to make sure that we got both of them pressed back in. Better for, it's easier assembly. Stuck there. Okay, so now I can either take this off and then this piece or I can take them both off just together. But what I got to do is I'm going to check these brake pads. They look like they're pretty good. So I'm going to check them if they're still good. We're not going to replace them probably. So wrong ratchet. What's your ears guys if you got your headphones in. Eat the right size. T50, T55. Well, yeah, T55. All right, here we go. So these take these hex things. I don't know. And you guys didn't see any of that. What I did was they take the hex, the torques. It's a T55. I took it out of the bottom here. I'm going to take this up here. I'll set it up there like that. Let's check these pads. As you can see these pads are in great shape. I'll have to check the other side. But if she don't need pads then she's not going to have to worry about the pads. Since she's got the rotors I am going to put some rotors on here because there is a little grooving from the last time she had this done. So anyway what I'm going to do is I'm going to take this piece off now. Yeah, thought I could get by with that. Now I'm just going to set this up in here for now. I got to go get a piece of wire. I don't like to leave them hang on the lines and I got to get me a socket that'll fit these two bolts.  It's got to come off anyway. So I do have this thing on jack stands. This is very heavy automobile. So that's the noise she was hearing. So and behind here is a set this up here. Up behind here is three bolts that I'm going to take out and that whole assembly should come out. Now a lot of times you may have to beat hammer but sometimes they come out real easy. So let me go ahead and get my sockets. Well I got some sockets right here. I don't know if they'll fit. What size them are. I think are metric. I will probably have to go get my metric. Metric set. This might work. Hang on. I'm using a three-quarter here. Yeah, three-quarter take that out. Move this out of the way. Now there's three bolts on the back of here. I'll take you off and show you what they look like. One here, one over here and one right down there. Okay. So I'm going to so I want to see if those will come out and if they will I'll just pop this whole thing off of there. Okay guys I got to do this again. Now I went ahead and I unplugged this. It's the ABS sensor. I've had this out of here once but I wasn't recording. So what you're going to want to do, this will fall out now but what you're going to want to do just tap that out just like that. This one came out that easy the first time.  It's heavy. They get all gooped up in here and they're real hard to get out.  Be real careful if you got to reuse that thing so you don't damage it. Now just clean this out and you'll put the new one in. Now I'm gonna show you what what this issue is with this one. Soon as she gets she went to go get one. It'll be a couple hours yet but see this bearing? See like that bearing there is laying on its side. It should look like the one next to it. So it's bad. Now these things sometimes they come with this with your ABS sensor. If they don't that's just like a little Allen head of bolt. Just Allen head of bolt. Take it out. Sometimes these are stuck in there. You got to be real careful or they'll break because they're plastic. So I don't know if it's got a new one or not. I'm just gonna wait but that's all there is to it. There's this three bolts I was telling you about. So there it is. Now since she gets back we're going to throw this back together and we'll have one side done. Okay guys I got this pretty well cleaned up. Nice and neat. They don't have to be perfect but if you've got any anything on here that might not let it go on straight you want to get that off but this one's pretty decent. So now we're gonna put this huge thing. This is heavy. See this one's got the cap on the back. I was telling you about earlier that one don't. Let's go ahead and this goes down through the center of that wire. It goes on like this. Just like that. Slide that in there just like that. Now we're gonna get one of our bolts started and grab my own bolt.  He was inside the house and he's got a plan outside any shed right there at the fence. Well thank you for being so nice.  Alright now we're gonna go ahead and bolt this up. Now this I want to come up and over. It gets hooked on there. See this up here right there I could have went ahead and pulled out like I was going to because it's already got the plastic pieces on it. Sometimes they don't so go ahead and pull this out. Okay now I'm gonna go ahead and just pull that out like that. This goes inside of here like this. Oh you don't see it. See that side there. It just clips in there. There it is. Clipped in. There's one up here at the top. After you plug it in it's got a hole up there at the top. Same thing with with all of them. It'll go up here. This one will go here. Just like that. Still a piece of this one stuck down in there. So then this will get. I'll have to dig that out because it doesn't hit this car through. So anyway this one's gonna get clipped here. So I'm gonna go ahead and I'm gonna tighten these down and then I'll show you how to put the rotor on.  Just like that. When you take these off sometimes they'll have this on. Sometimes they won't. This one had it on. I'm just gonna go ahead and push that back on there. It's not necessary. You don't have to because the wheel will hold that on. Now I'm gonna go ahead and we're gonna put our mount back on here. Just a upper and lower bolt. Just like that. I was gonna put new brake pads on but these pads are still at about 90% so I'm just gonna reuse these ones. Normally I don't but if it had been down about 75% I wouldn't but these like I said they're about 90% left. So I'm not gonna replace them. Watch your little squealer there. When you get to squealing your brakes make that little noise. That little metal tab right there is what causes that. Right there. And that's put on their purpose to let you know that you're getting down to where you're gonna need brake pad or brake yeah brake pad. So that one let's see. Looks like this one was on the piston so I'm gonna put it back the way the way it was on there. It's like that. Put one up here like this. It's like that. Now we put our caliper back on. I didn't have to wire this up because it sat right there perfectly so that way it wasn't hanging and now a little bit of grease right here this brake grease. I've actually seen guys put it on here you don't put it on there.  If you notice if you guys done this before sometimes this brake grease is white you can use Vaseline on these things. It doesn't take a lot. It just keeps it from well like I say making noises and stuff. You can also put a little bit up here right there at the contact points. It just takes takes a little bit just like that. That's really all you need to do. Now where's the bottom one? Then clean your rotor off real good. Some of them have a coating, a protective coating that sprayed on there. This one does not. There we go. I'm going to tighten these down and then that rotor will line up once you put your wheel back on and like I said these are 55 T55s and tighten these two down and you're pretty much done. Well for one side. Other side I'm just going to check it. I don't think I'll have to pull it apart. I'll just pull the wheel off and look at it and look at the brakes. They should be alright. If not I'll go ahead and put new brakes on both sides. So she's also wanting an oil change. Rear pads put on. Temperature gauge is not working. I know what that is. It's the plug. The plug's broke on it. There you guys go. That's it. No greasing. No nothing. There it is. Alright so all we got to do is put the wheel on and we'll set the brakes up. That's when you just pump them up until you get a good pedal and they're set up. So no bleeding. You don't have to bleed the brakes because you didn't have the caliper off. So alright. Let's put the wheel on. Okay guys. So there you go. That's the wheel bearing assembly on the 2003-2004 right in that area. I'm not exactly sure what years but there's several different years. It's identical to this. Excuse me. So it's how you do it. It was going to be a brake job but the next video will be doing the rear brakes on this thing. They're a little different from the front but they're still pretty easy. So yeah I'd say it was going to be a brake job but I checked the other side. Brake pads are just fine on there too so I'm not even going to pull them. She can either take these back or keep them you know for when she needs them she'll already have them. So they're not real expensive but like I said normally if it was down to 75 or 80 I would consider putting them on but there's still 90% left on here. I can't see her putting them on yet so you know it should be alright now. In fact I may she's got another rotor. I may just go ahead and replace the other rotor on the other side. I think I'll just go ahead and do that. Maybe maybe I'll just do a video on that.  Yeah I'll make a video on that. That way if you just have to change the rotor you'll see you'll see what it involves. So anyway guys thanks for watching. Shea Bear the myth man legend. I'm gone for now. Bye bye guys. Take care. Thanks for watching.


The Tiger, Financial News Network. Welcome folks. We have our industrials finished down to 67 in Aztec off 13, 8 S&Ps down to 19. Gold contract trading down $5.50 at $19.69 an ounce. We had the silver contract down 19 cents at $23.68 an ounce. Light sweet crude up $2.19, $81.68 a barrel, notes and bonds. Venue note, down 17 ticks, $108.00 AMZN, I just want to bring this up on the other screen so I can keep an eye on this thing. Okay, so then a King dollar. King dollar right now traded down 69 ticks at $102.21, the Euro at $109, the Yen trading at $142.00 and the British pound at $127.00 to one US dollar. We go take a look at, well, let's see, that just popped, okay? So someone just came out, is it just, let's see if it's Amazon, the NQ's just popped. That must be Amazon because there it's at $134.00, so Amazon, net, third quarter net sales $138 billion to $143 billion, the estimate had been $138 billion, so it's at the higher end. Net sales beat estimates, yeah, net sales beat estimates, okay? This is going to be all over the place, that's for sure, but let's see, right now that's trading higher by $8.00 and then Apple's not going to be coming out until 4.30, folks, okay? So let's see what else they have right now, it's just net sales beaten, operating income 7.00, oh, look at this, look at this, man, oh, this is crazy. They can do anything they want with this, with Amazon, you got to love it. Operating income, the estimate is $4.72 billion, they commit with $7.68 billion, that's amazing, man.  Now that being said, just wait one second, now it's still at 1.35, it's still at 1.35. Folks, have a great night, have a safe night, come back and visit Tommy tomorrow morning, kicks us off 9 a.m., great show, Apple's are going to be, Numbers are going to be coming up, you know, we get volatility, volatility is the trade, it's best friend, folks, have a great night, have a safe night.


Dedicated to the strength of the nation, now heard on more than 1,300 radio stations. Proudly, we hail. We hail starring Billy Burke in the fabulous Deleers, the United States Army and United States Air Force presentation. And now here is your producer, the well-known Hollywood showman, C.P. McGregor. Thank you, thank you. And greetings from Hollywood, ladies and gentlemen. Welcome to your Theatre of Stars, where the motion picture world's finest talent appears in Pleasure and Joy. Billy Burke is our proudly we hailed star and appears in a brilliant comedy, The Fabulous Deleers. Miss Burke portrays the mother of a very confusing family and does so in her usual excellent manner, with hilarious situations. We'll have the curtain for act one of our comedy in just a moment. But first, Wendell Niles. Friends, your representative abroad is the U.S. Army or Air Force man. Both abroad and at home, he represents a free way of life, a nation devoted to peace. His is an honorable and respected career. That's why so many of the best young men in America are volunteering for a career in our Army or Air Force. Your soldiers and airmen are engaged in a work that is increasing their personal stature in the eyes of their countrymen and at the same time keeping America strong and at peace. Now once again, our producer. It's curtain time and here's act one of The Fabulous Deleers starring Billy Burke as Cynthia Deleer. The Deleer family was comprised of four. There were three children now growing up, Nancy, Pete and Christine. There was the mother, Cynthia. And that was what perplexed the neighbors. How a mere four could create such constant pandemonium. He has to say that Cynthia Deleer and her family were merely eccentric as bearing very unkind to adjectives. But let's drop into the Deleer living room and observe them in person, all but mother who hasn't arrived home yet. Why doesn't someone answer that? I'm busy, but you get it, Christine. When you're certainly a revolting spectacled lolling about like a washed out beachcomber, I thought you said you were busy, nature boy. I'm busy relaxing. Anybody live here? You call this living? What do you want? Well, if I must be explicit, your furniture. Are you Mrs. Deleer? No, I'm Miss Deleer. Look, would you mind saying what you said over again? Well, it's very simple, Mr. Deleer. I represent the firm of Hackett and Chase. They're lawyers and they represent... Don't tell me. Let me guess. Oh, let me. Our creditors. Right. I've come to collect on the assorted notes they hold. Or you take the furniture? That plus the house, the grounds and other tangible properties. Oh, no. If you promise to take tone debt over there at the piano, it's a deal. Pete, I heard that in our reservation. Oh, this is awful. I'm sorry, Mr. Deleer, but that's the way it is. Please understand it. It isn't anything personal. I just happened to be working my way through law school with this job. Oh, dear, there's always some trouble.  Thank you. Sit down anywhere you like. The furniture's yours anyway. No, listen to that. 88 notes to choose from, and she can't find a good one.  In any way, the man's come for your piano. What did you say? This man wants some money or out everything goes. Well, where's... Oh, oh, pardon me. This is my sister Christine Deleer. I'm not seeing. This is Pete. Hi. My name's Newell. John. Hello. Well, why on earth didn't mother pay these people? Could be. She didn't have any money. I read somewhere there are people like that. Don't be flippant, Pete.  At least there always is on the first of the month. This is the tenth. No payments have been made for two years. Two years? Oh, dear, this is terrible. And Hackett and Chase have reached the limit of their patience. You can't blame them. No, no, I suppose not.  There's no tea, I looked. Coffee? No, we're out of that, too. You, you're on business. Oh, but, well, that's no reason we can't be friends. No. No, it isn't. You know, you're really all right. I, I am. You really are. Oh, I just realized my hair. I haven't finished drying it. Oh, I like it that way. Reminds me of, of limp noodles. Uh-uh, a conquest, Nancy. You'd better take advantage of it. Well, so long as you're not taking the piano today, I think I'll go meditate on my concerto. Get lost, Christine. Children? Oh, here's mother now, Mr. Newell. And Newell, I'm warning you. From now on, anything can happen. Oh, children, I've had the most wonderful afternoon. I, oh, oh, what a charming young man. You must ask him to stay for dinner, Nancy. He came to see you, mother. Well, he can still stay for dinner. Oh, but children, I want you to see what I brought home. I found him in the park. Lo, oh, come here.  Yes, ma'am. Good heavens. Who on earth is that? His whole name is Mordecai Smith. That's right, folks. But my friends call me Mo. You guys can call me Mo. Mo can cook. You mean, really? Isn't that wonderful?  We need you. Yeah. You know how it is, living alone.  So I took up cooking to take me mind off me stomach. He was head chef at Leavenworth. But, mother, that's a penitentiary. But, of course, it is, darling. Mother knows that.  Yeah. But I always got out on good behavior. But what was to use? I only had to go back again. Oh. After all, a guy has to eat, and nobody would give me a job. You know how it is. Yes, yes. Indeed, yes. We know. But, as Shakespeare says, sweet are the uses of adversity. No, mother, not Shakespeare now.  And this hour life exempt from public haunt finds tongues in trees, books in the running brooks, sermon in stones, and good in everything. Gee. That was swell, lady. You can sure really do. You know any more. Know any more, my dear man. I was one of America's foremost Shakespearean actresses. Mother, you must listen to me for just a moment. Mr. Newell wants to talk to you. Oh, how nice. I shall adore talking to Mr. Poole. Uh, the name is Newell. Oh, I'm sorry. And we'll talk in a minute. But first, I must get Mo to work. Wanted I should make you a cake for dinner? You can bake a cake? Sure. Show me a oven. Brother, if you can produce a cake and our bear an excuse for a pantry, you're a magician. Peter, our larder is loaded. Show Mo our beautiful kitchen. Ah, come on, Mo. It's up to you to produce a cake. I'll be right in, Mo. Oh, dear, I'm so happy about him. He's going to stay here and cook for us. Any ex-convict live here? Well, why not? The poor man has to live someplace. Mother, it won't matter about Mo because he won't live here. You won't live here. None of us are going to live here. Mr. Newell has come for our house. Good heavens. So early in the afternoon. I wouldn't think of letting him take it now. Everything's so messed up. And besides, Mo's using the kitchen. Mother, you don't understand. Mrs. Deleer, the collection company I represent has a lien. They're coming tomorrow afternoon to take over. The furniture and everything. Oh, dear. Why didn't you say so in the first place?  What are we going to do? I don't know, Mrs. Deleer. But my good young man, you must think of that. You just can't come dashing in and taking everything out from under us, making some without some provision. Well, I simply won't go to that clock hotel. It's grim. Don't you think it's grim? That lobby, for instance. Now when I was studying interior decorating, I was no more... Mrs. Deleer, you can't blame Hackett and Chase. I beg your pardon. Mother, that's the name of the firm he works for. It's not up to them to take care of us. We've got to take care of ourselves. You know, they haven't been paid a cent on the mortgages for two years. Well, really, do you have to rush things so, Mr. Drew? The name is new. Oh, I'm sorry. But actually, must we all be so downright serious about this simple little matter? Oh, Mother, it isn't a simple little matter. We've got to raise money somehow to pay them, or out we go. That's right, Mrs. Deleer. And you look like such a nice young man.  Never trust a good-looking young man. Mrs. Deleer, I hate this as much as you do. It's a very pretty speech. But it doesn't give us back our house. I know, but... And another thing, you simply can't take the house till after next Wednesday, because next week is Boy Scout Week. Boy Scout Week? Yes. Mother, what in heaven's name is that to do with taking our house? Well, because I felt I should do something about it. I don't ever want it said of me that I don't do my part in the building of youth. Ah, yes, yes, I know. But, Mother, what's that to do with Wednesday? I just dropped into Scout headquarters. I invited the Scout master to lunch, and he's bringing a Boy Scout along. Remind me to get that youngster's name, dear. All I can remember is that it began with a T. T... Oh, no, no, no, no. I want to have place cards. Oh, Mother. Mother, we can't even feed ourselves, let alone a hungry Scout master in his charge. Well, still, we must do our part, dear. Oh, we mustn't be selfish. Take the house. I'll be given time to think this over.  Well, I don't believe in making snap judgments. Yes, I can see that. Besides, it wouldn't be fair to you to hack it and run or whatever their silly names are. I'll call you tomorrow, Mr. Crue. Newell. Oh, yes. Well, tomorrow then, and we'll have a nice long talk. Goodbye. Oh.  Yes, yes, isn't she?  Well, maybe I can talk to my bosses. Maybe there's some way you could make payments. Look, none of us earn any money. We don't know how. We only know how to spend it. You see, we get an income, a small income, but that's gone almost as soon as we get it. Oh, Mr. Newell, you've been very nice, and I'm afraid you must think that it's pretty incompetent and silly. Well, the Deleers are kind of delirious. Oh. But I, uh, I'd like to come back and see you. I mean, when I'm not on business. Nancy! Yes, Mother? Tell Mr. Newell not to slam the door on his way out. Most cake will fall.  Oh, Mother! It's all right, really. Besides, you finally got my name right. The pause briefly from our story, the fabulous Deleers, starring Billy Burke, to bring you an important message from your government. You young fellas who want to fly, you remember that U.S. Air Force plane you saw winging through the sky the other day? Well, a pilot was a young man interested in aviation just like you. He had completed two years of college, or maybe he passed an equivalent exam given by the Air Force. He was single between the ages of 20 and 26 and 1 half, and had met the physical requirements. He went to aviation cadet school. He learned all about airplanes, their engines, how to pilot them, how to chart his course. After a year of this training, which he completed successfully, he was commissioned a pilot in the U.S. Air Force Reserve, or maybe he qualified for a regular commission. Either way, his pay now ranges up to $336 a month, and he's doing what he loves, flying. Why don't you find out if you can qualify for aviation cadet pilot training? Ask at any Air Force base or recruiting station right away. Our curtain rises in act two of the fabulous Deleers, starring Billy Burke as Cynthia Deleer, the incredible Deleers, about to be dispossessed from their home in a foreclosure threatened by Hackett and Chase, don't seem to be too much concerned about the crisis. Led by their whimsical mother, Cynthia, they have gathered around the dining room table and are enjoying the cake prepared by their new chef, Moe. It seems the Leavenworth loss was the Deleers' game. Boy, what a cake. Gosh, folks, I'm glad you like it. Oh, Moe, it's grand. We live like this from now on. Cakes, pies, everything. Moe says he can cook everything. Yes, ma'am. At Leavenworth, I cook for $3,000 and three meals a day, too. $3,000. Think of that. Moe? Moe, I've got an idea. Children, it's a wonderful idea. Now, Mother, please, no more ideas. We're in enough trouble as it is. But this is an idea that will save our house and furniture and everything. We'll open and in. We'll call it the Cafe de Deer. How vulgar. Anything that makes money is not vulgar, Christine. If Moe can cook for 3,000 people, why not just it? Wait a minute. Maybe Mother's got something there. But imagine us running an inn. Can you imagine what other people do and make money? Wednesday, we'll have Mr. Newell. Am I right? Yes, Newell.  Pete, I think you're right. Mother does have something there. I'll be hostess. I've got a lovely teagall. It will be just the right thing. Nancy can be cashier. Pete can wait on the table. Christine can. Well, what can Christine do? Just as long as she doesn't play the piano, she can do anything. Mother, for once in your life, I really think you've got a paying idea. Well, of course I have, dear.  Now, let me see. Oh, dear. I wonder where we should sit, Mr. Hurkett. Hurkett. Hurkett. I mean Hackett. Oh, Pete. Hmm, lunch smells wonderful. Pete, where shall I put him? Where should you put who, Mother? That dreadful man whose name begins with an H. You know, for the house. Oh, well, the house is practically his. Put him at the... Perfect idea. By the way, Mother, what became of my black silk dressing robe? Oh, I gave it to MacCrucio as a recloak. MacCrucio? I never heard of him. Oh, don't be tiresome, Pete. He's perfectly marvelous character. Lived in Elizabethan times and had a violent temper. Was run through with a sword. Died beautifully. You don't mind, do you, dear? Oh, no. Loaning your robe. We're doing Romeo and Juliet at my dramatic class. I think costumes help such a lot. Hmm. You haven't got enough places at the table, have you? Of course I have. One, two, three. Oh, the Boy Scout. The Scout Master. Boy Scout? Yes. Remember, this is Boy Scout week in our city, and we must do our part. I'm sure Boy Scouts are always hungry, so I invited one to lunch. Only I still can't remember his name. Yeah, this was... with a T. Yes, T. He must be a very fat boy because the Scout Master said it would take a lot of food. Well, I guess Mo can take care of that, all right. Well, then I must find Christine. She's to play. She only knows one piece. The tale of the Vienna Woods. Be sure she plays that or we're dead. Oh, I'll make sure. That's so lovely with lunch. I always consider Strauss an excellent aid to digestion. Christine! Oh, dear, I didn't know it was so late. Nancy answered the door, darling, right away. Father, a good morning, gentlemen. Good morning, Mr. Lear. Mr. Lear, this is Mr. Hackett, the head of the firm. Mr. Chase couldn't get away with it. Never mind all that. I'm in a hurry. Just want to look things over, Miss. See what condition furniture's in. Cigarette burn, just as I thought. Now look here, now! And that cane, see that needs bending. Oh, and a wine stain. Disgraceful. Totally irresponsible people's plain to see. But every house, sir, has minor accidents now and then. Yes, yes, yes. But they've been repaired. Immediately repaired. Time saves nine, you know.  Hey, hey, Mrs. Dillier, go to the sea. If them church's down at the market, forgot to be... Oh, excuse me. Who's this creature? And stop waving that knife. Who, me? If I was to see that butcher, I'd use this knife. Mo, Mo, do go back into the kitchen. How do you do, gentlemen? How do you do? This is Mo, you must mind him. He's just out of Leavenworth. And a little unrestrained. This is a plot. Mo, never really killed anyone. Except accidentally. And you'll forgive him even that after you've had lunch. Lunch? Why, who said anything about lunch? Well, that's what you're here for, didn't you know? Oh, dear, dear, why don't people tell people things? I never eat lunch. My Libby, you know. Oh, I'm sorry, but how lovely. Because that leaves more for him. The Boy Scout. There's one coming for lunch. I told the Scoutmaster that the members of your firm are treating us hosts to him because you know this is Boy Scout week. Oh, well, really, that's something of an imposition, madam, you know. You really are, you know, after all.  Well, I hadn't thought of that. Then everything's settled. You'll stay. Oh, of course you will. How lovely of you. Just put your briefcase over there and make yourself at home. Excuse me, I won't be a minute. Then we'll have lunch. What's that?  Now, keep your heads, children. Don't stand under any falling bricks. Well, I don't know. I guess it's the Scoutmaster with that young master, T. Haven't I forgot to get his name? Oh, so he's brought friends. Friends? He's brought a whole troupe. Troupe? That was his name. Well, how wonderful of you to think of it, young man. There's no wonder the Scoutmaster was worried about food. Oh, Mother dear, you didn't invite one scout. You've asked a whole troupe of them. A whole troupe? For lunch, ma'am. Oh, how nice to see you, Mr. all of you. Now, you must meet my family. This is my daughter Nancy. Say hello to Scoutmaster. Troupe, dear. The name is Hill, Mr. Lear. Glad to know you, Mr. Hill. And my daughter Christine. Glad to know you, Mr. Lear. Mr. Newell. And this charming, charming gentleman who has so delightfully offered to act as a host. Mr. Hackett of Hit and Run. Correction, please. The names are Hackett and Chase. I'm hit it. I mean, I'm run. Oh, what am I saying? Oh, well, what's in a name? A rose by any other. Wood smell. Now, everybody, just relax. Boys, the place is yours. Dally as you will at the Café de Lille. Take over, Nancy, darling. I must away to the kitchen. Oh, but, Mother, you can't leave me like this. What am I going to do? If we don't feed everybody, we'll be the laughing stock of the town. You've got to do something. You fed 3,000 men at Leavenworth. You've only got to feed 50 here at Delirium. Only one thing stopping me, ma'am. The grub. All I need is a truck garden and a Texas steer. Wait. Why didn't I think of it before? Mo, listen to me. You will do this. And we'll have all the food we need. Now, listen carefully. Give our thanks to Mr. Chase, too. Well, you got through it all right. Both our names. A wonderful troupe. Wonderful boys. Such leadership.  Hack it and chase our proud to be your host. And as for our lovely hostess... Oh, yes. Um, those papers... Oh, forget it. From now on, we're really partnered. It's Café de Lille. Any woman who can cook for a whole troupe of unexpected guests. Oh, he's nothing. Oh, yes. And show them such a good time can do anything. Mrs. De Lille, the town is yours. Oh, bless you, no, Mother Darling. I guess I was wrong. Once in a while, you do have an idea that works. Well, of course, dear.  I want to say this, Mrs. De Lille. This has been one of the most pleasantest days of my whole life. And if this has run you... Well, run you into any extra expense, now you just charged it to me. Oh, how sweet of you. But don't worry, since you were the host, I have already charged it to you. Wasn't that clever of me? Ha, ha, ha. The fabulous De Lille's. Our star, Billy Burke, will return for a curtain call after this timely message from Wendell Niles. High school graduates, here's how you can go on with your education while establishing yourself in a worthwhile career. The answer is the U.S. Army. In the Army, you'll learn to master one of many skills or trades. You'll be working with other fellows your own age. You'll receive good pay, and you'll have the chance to see some of those foreign countries you've read so much about. And here's where the schooling comes in. You can study courses of your own choosing. It's true, just about any course a young man could ask for is available. You take these studies through the Armed Forces Institute, and the only cost is a nominal registration fee. Yes, high school graduates, the Army gives you two big opportunities in one offer. Further education and a career with a future.  Get the facts for yourself. And I'll once again our star, Billy Burke and our producer. Ladies and gentlemen, I want you to meet the star of our show, the very clever and charming lady, Mrs. Florene Zegfeld, better known as Billy Burke. Thank you. Billy, after 18 happily married years, I don't suppose anyone in the world knew Florene Zegfeld as well as you. And I was just wondering a while ago if you were going to write his biography. Well, you know, will Rogers, before his untimely death, insisted that the story be written about flow? And? Yes, I'm going to do it as soon as I return from New York. You know, the Schubert's and I are preparing another follies, the new Zegfeld follies. Isn't it wonderful? So many of today's headliners in the entertainment world were Zegfeld discoveries. Yes, indeed. There's Eddie Cantor. Oh, yes. You're with him now on his radio show. Yes, I am. And enjoying every minute of it, he's so wonderful. And besides Eddie, Flo discovered Will Rogers too. I just have to mention his name again. And then there was Fanny Brice and Virginia Bruce, Ina Claire, Irene Dunn, Paulette Goddard, Ruby Keeler, May Murray, and Billy Burke. Oh, how sweet of you, T.P. T.P. And in addition to the stars he discovered, his production formula still stands as a criterion of show business. Well, you mean, for example, he's having brought the ballet into musicals, among other things. Oh, yes, he was far ahead of his day, wasn't he? Yes, indeed. I know we're both on our favorite topic, Billy, but before I tell you about next week the stars, I just want to say I'll be looking for your book on Zegfeld and this year's edition of the Follies. Oh, thank you. And I'll be dialing you away next week. Who's playing, T.P.? Well, she finally got it right. Next week, Billy, and ladies and gentlemen, Victor Moutour comes our way to star in a bright comedy as a very noisy but lovable Kelly, who is saved from a jail sentence by a lady attorney who, in turn, gets both herself and Kelly jailed. You'll like the irrepressible Kelly. What does C.P. mean? City, police, hm? Well, oh, it's been lovely talking to you, but really, I must hurry along now or I'll be late for Mr. McGregor's curtain call. Goodbye. Goodbye, Kelly. Please show the join us next, ladies and gentlemen, when we present Victor Moutour in Honeymoon for Three. Until next week, this is C.P. McGregor saying thanks for listening and cheer y'all from Hollywood. The awards are the courtesy of the Hollywood Coordinating Committee which arranges for the appearance of all stars in this program. The orchestra is under the direction of Eddie Stravandov. This program is rebroadcast to the Armed Forces Overseas through the worldwide facilities of the Armed Forces Radio Service. Remember, proudly we hail next time presents Victor Moutour. This program was transcribed in Hollywood for release at this time.


Searching buildings or anywhere up close when it's dark out can be tough. There are several considerations we want to think about for low light searches. And the assumption is in this this type of scenario is that you are searching your house. You heard a bump in the night and you're going to go search to see what's going on. And you have you have reason to believe it's not just the dog or the balloon popped from the birthday party, but you have reason to believe it's a little bit more serious. Of course, the conventional advice is to call government, have the government come and save you. But if you chose to or were required to protect yourself, you'd want to search your house. So as you're going through your house, the problems with current lights are that most of them are way too bright. And you don't want a light that's too bright. Why not? Well, there are times that you do. The time that you would want a bright light is when you find bad guy crouched there trying to hide in the corner. You want to be able to blind them, light up the whole room really brightly, make it so that when he looks at you, he can't see you, but you can see everything. Definitely want a bright light for that.  They're going back and forth each time. So when there's a lot of light, your eyes, pupils go down really small. And then as soon as the light goes off, it takes some time for them to come back so that you can see. And so this is why you just go into any room and just practice this, have the lights turned on, turn the lights off, and then see how many seconds it takes for you to be able to see whatever object on the other side of the room. If it's just a very faint light. So this is one problem. Bright lights are just not good for searching because now you're delayed two, three, four seconds until your eyes are back to where you can really see things well. So while you're searching, you actually want a fairly dim light. Well, one of the ways that this is people who tried to fix this over the years has been with lights that have a your first click is really bright.  Maybe you have a third click that's a red light that's even less. It's not going to blind as much. It's just it has other, you know, somebody 200 yards away is less likely to see it. And then maybe the next switch is a flashing red light. Maybe the next light is a strobe. But the problem with these things is that when you're in a panicked situation, this doesn't apply to the people that are out there fighting in 10, 20, 30, 50 gunfights a year. If you're a special forces type person, you're trained and experienced enough that you're not panicking necessarily every time you're in one of these situations. But for the other 7 billion of us that are just kind of peace living folks that hang out in our houses and don't try to go out and start fights, we're not going to have that kind of experience that mental toughness. So the chances of for us being able to remember, oh, I need to go three clicks to get to my dim light for searching. And then I need to go two more clicks to get to my strobe once I found him to distract him. But now I'm ready to shoot because now he's pulled a knife out. So now I need to change it to the bright light. You're not going to be able to do that. It's just not going to happen. We wish we could, but we're not going to rise to that level unless we have trained and trained and trained and trained and trained with really good realistic training. So knowing that that's probably not going to happen. A light has to be really simple. That's to have buttons that you can feel. Here's another thing that it needs to have. You can't have a click, a click on and off where it makes an audible clicking sound. You want it to be nice and quiet so that you can move through the house, do your momentarily, momentary push.  So you do your momentary light of the area that you're searching.  Now it's dark. You change your position. In case there was somebody there that wasn't in the area you were searching, they start shooting at you. You don't want to be where you were when the light was on. So you've moved over over to the side and then you light up another area, turn the light off, move to another area. This is the preferred method for most people who search buildings. So we want to have the momentary on and off. We want it to be simple. We don't want it to be too bright. So how about simply having something attached to the gun? A weapon-mounted light. Brilliant idea. I suggest that everyone has a weapon-mounted light. They are wonderful. What a great invention. Definitely have one of those. Again, my tactical ring light is not to take over that market. You need to have a good weapon-mounted light. It's a good idea to have a nice everyday carry light that's in a belt loop if you're going to carry it. Not arguing about your surefire or any of your great lights. Keep those. They're wonderful. But you want to have something that's always with you and that you can still flex your hands. So if you have your wonderful surefire light and you need to open a door, you risk the light bumping against the door knob and making a noise. You risk dropping it as you're grabbing the door knob. So it'd really be nice to have something that's hands-free. Well, to solve this, people have made gloves that you can slide onto your hand that have lights attached to them. But so far, nobody's come up with a good one that has a momentary on-off switch that has the light directed in the perfect direction for a gun. Yeah, so that's not the perfect solution. I've actually purchased everything that I can find out there.  They pretty much just all suck. Okay, so we need it to stick to our body. We still need to be able to do things like I mentioned, to turning the door knob. We need to be able to get in a fight and not have it fall and roll away. When I say fight, I mean a fist fight or grabbing someone or that kind of thing, we need it to stick with us. So that's why I made a light that mounts to our finger. Now we can't have it mount so strongly that someone can grab the light in a scuffle and use that as a way to hold on to us like you'd grab somebody's ponytail or something. We're not going to give them something to control our body. So I made this in such a way that it's easily breaks away if you're in that tussle kind of situation because you'd rather lose your light than lose your finger or have them have complete control of you. Now another reason that the weapon mounted light isn't perfect and actually is the primary reason is that not everything that you want to illuminate do you necessarily want to point your gun at. So you're searching your house and your spouse says from behind you you can hear their voice they say honey I found this jacket laying in the hallway is this yours? Well when you turn around to look and see to see if this is bad guy's jacket if you're not even sure there's a bad guy there well if there is a completely strange jacket of the house might be good to know that. So yeah you definitely know it wasn't just a something falling a broomstick falling in the closet falling in the closet because it was balanced poorly. It'd be good to know that well you don't want to really illuminate your wife in that jacket turning your


Welcome. I'm Craig Thomas, your host on Much More Medicine, part of Think Tech Hawaii's live stream series and assisted today by engineers Rich and Eric. And with me today is Dr. Will Scruggs, an emergency physician and chief of staff elected at the New South Castle. A longtime active member in the local chapter of American College of Emergency Physicians, the group that is sort of our steering and public voice. And thank you for doing that over the years. Congratulations on your new administrative role at Castle, which is going to be challenging and interesting. I'm delighted you're here. Thanks for having me. It's good. I was hoping this morning that we could talk about, first, sort of the current state of emergency medicine from your perspective. You staff, among other places, as we said, Castle, which is a very nice and sort of classic community emergency medicine department, which is where the kind of department most emergency medicine occurs across the country and the kind of department our group staffs a bunch of. And the tertiary centers get a lot of press and TV shows labeled after, but most of the work honestly gets done in the communities that surround the tertiary centers. So what's the state of emergency medicine this year? It's an interesting time. As you and I both know, we both have the advantage of having worked at numerous facilities all over the state and anywhere from busy county-type facilities to the suburban facilities like Castle to a real small, very small emergency department in 24-hour shifts to see 10 to 15 people in that time. So we've both seen the spectrum of that. Yeah. It's a great thing, actually, isn't it? It is. It's a very rewarding way to see emergency medicine, kind of see all of it. And it's an interesting time in emergency medicine because things have changed so much in medicine in general. And watching our specialty come from where it started in the 70s as kind of a positions that didn't really fit anywhere else in medicine start to provide these services that were very much needed into the first emergency medicine residency. I think it was in 72 or 73 at U of C to now being one of the most popular specialties of choice for medical students as they go into residency. And nowadays, becoming part of the larger picture in medicine and really trying to take control and expand our niche in medicine to try to, I should say, when I say expand our niche, it's important that we're just trying to fill the needs of our communities and serve the people that come to see us every day. Yes. And you're right. That's sort of the arc. When I graduated from medical school in 1980, I think there were five residencies and more than 120 now. I don't know exactly. I think so. So that's a big change. And also, when we started, it was kind of like, well, you can staff it at night and maybe take care of the weekends, but us real doctors will be taking care of everything else. And now most doctors stay away from the emergency department because they don't want to know what's going on in there. I mean, it's become its own, clearly not only its own specialty, but its own set of expertise. And expertise is an important word. Other specialties don't come. The emergency room is often because we can take care of most of it. And we know when we need to get that specialist involved. Yeah, I was heard, in fact, I think this is the best definition of the sort of core practice, which is experts at the first hour of everything. And pretty clearly sooner or later, things have to get handed off. But you have to recognize what it is, start the right stuff, call the right people. And those are for things that need additional care. Obviously, we can do a lot of complete care. But some things need services that you need a specialist to provide. So from my perspective, the world of medicine has changed dramatically since I started. Not only has emergency medicine become a key player, in fact, I think in some ways the hub of medicine, acute medicine. But the other elements have changed too. So when I started, the primary care doctors often saw their own patients in the emergency department. And if they needed admission, admitted them. And that doesn't happen much anymore. And hospitalists were a rare breed. Now you have the outpatient world, the inpatient world, hospitalists and the associated specialists. And in between you have us. And I think we've become the urgent and emergent diagnostic and treatment hub. And I think we need to figure out the pieces that would make that more efficient and effective. And from my perspective, that's the current state. And we should focus on things we can do that would improve that going forward. What are your thoughts? I agree. I think we are the diagnosticians, the acute care diagnosticians in medicine now. And people come to us for a reason. We're good at what we do. We have the capabilities in our emergency departments because the hospitals have given us all these diagnostic tools at our disposal. They need to move people quickly through the emergency department so we can take care of the next person. And so we have these tools. We can use them quickly. We have a very efficient way to make the diagnoses for people. And then I think the next steps are sorting out the communication issues that we have. Because in the past it wasn't these discreet entities. It wasn't a discreet hospitalist service. And for those who don't know what a hospitalist is, they specialize in taking care of people in the hospital. They do a very nice job of that. But they've only started up in the last 10 years. But most hospitals now have hospitalists. And so you have these discreet inpatient acute care physicians. In the past, as you mentioned, primary physicians would take care of their patients out of the hospital. And then they would do the admissions themselves. And that doesn't happen any longer. And so now figuring out how we're going to connect those pieces is what's really key and how to do it efficiently. It has to work within our workflow, right? So we're talking about how quickly we can make a diagnosis because we have these diagnostic tools available to us in the emergency department. Within an hour or two, we can usually get to the idea of what's going on with the patient, whether or not they need to be admitted, if I need a specialist involved, or if we need to send them back to their primary physician for further management. And so we have to address those communication issues within that two-hour time frame. And technology should allow us to do that. But certainly I don't think any of us would say has met our needs, or more importantly, our patient's needs. And for me, at least, that's the next big step. There are a few things people have tried. And around the country, there's any number of ways people have tried to address this. Here in Hawaii, we have the Hawaii Health Information Exchange. We have talked on this program in the past about the EDE Information Exchange that Adventist Health Castle signed on to. And we expect other facilities in the state to sign on to that would allow rapid transmission of information for anybody who comes into our emergency department about what other facilities they've been to recently and potentially what other diagnostic studies have been done, what their medical problems are, do they have advanced care directives, all those things that we need to know in a relatively short time window that the old process of calling a facility in the middle of the night and asking for the one person who has access to that information, begging them to please stop whatever they're doing in their busy lives and jobs already and fax us that information and expecting the fax machine to work. All these problems that you and I have seen on a daily basis, the dots don't always line up to make those things happen. To me, that is the next big challenge in emergency medicine is connecting those dots and giving us the information we need to take care of our patients. I think you're exactly right. And just to reiterate the importance of this, medicine's changed in a lot of ways. The way communication requirements have changed is if you were the outpatient doctor, the family practitioner or internist, who did the ED visit admission inpatient management and then saw them back in your clinic, information transmission is much less important. But if it's three different sets of providers and then back to the first one, now you got an issue. The other thing that's changed and you touched on that is the explosion in diagnostic capability. Now, this is mostly a great thing. We're going to talk a little bit about utilization in a minute, but it's mostly a great thing. But it means you need to have access to those results. And it also means that it's highly likely when you come to the emergency department that we'll have the tool needed to figure out what it is that's impacting you. Now, there may not be a therapy. I think our diagnostics often exceed our therapeutic capability. But still, you need to have access to what's been done before. And one more piece of this is patient expectation. And an appropriate expectation, they look at their email and see that within a few seconds, they can get an email sent from a family member across the country. But we can, in medicine, figure out how to quickly access information at another facility. They are frustrated by that. And appropriately so, and we're frustrated by that too. But their expectations are that we should have access to the information and they're not very forgiving. And I don't think they should be necessarily if mistakes are made because we didn't have access to the information that should be readily available. I agree completely. You know, I kind of refer to it as, you know, the branch bank situation. Namely, if I make withdrawal at one branch, the other branch knows about it. Same thing should be true of one clinic or emergency department onto the next. We're going to talk after the break about some examples of other ways of becoming more efficient and providing better care. And also some therapies that can be initiated in the emergency department. So again, this is Greg Thomas with Dr. Will Scruggs, much more on medicine, see after the break. This is Think Tech Hawaii, raising public awareness. I'm getting older. Do I need to worry about falling? Yes, you do. Each year, one in four people, 65 and older, will experience a fall and many will be serious. The majority of falls happen at home, so remove things that could make you trip and install handrails to keep you steady. To learn more about the steps you can take to help prevent a fall, please talk to your doctor. You can also visit aarpfoundation.org or Medicaremadeclear.com slash falls. This message was brought to you by UnitedHealthcare and AARP Foundation. Aloha. I'm Marsha Joyner, inviting you to come visit with us on cannabis chronicles, a 10,000-year odyssey where we explore and examine the plant that the news has given us and stay with us as we explore all the facets of this planet on Wednesdays at noon. Please join us. Aloha. Welcome back. This is Craig Thomas, your host much more on medicine, and with me is Dr. Will Scruggs, emergency physician and chief of staff elected at Advent Health Castle. Nice to see you again. Before the break, we were talking about the, I would say, history and evolution of emergency medicine and sort of current status and challenges. I thought we should talk about a specific example of something that historically has not been done in the emergency department, is an example of a way emergency departments can meet a current health issue. And I think there are many examples that are similar and this might be a model. So let's talk about Hooper and Orphan. Yeah. So I think the opioid issue in general is a great example of all of the things we just talked about. It's exploded in the last five to 10 years. There has been an issue with communication in terms of us trying to find information related to patients prior experience with medications, with drugs, with the active prescriptions that we're receiving, communication between providers to make sure we're not overdoing it with those medications, diagnostic studies that have been done along the same lines. And to me, the opioid issue is one that we, I think, in emergency medicine, very much be a part of solving. I think so, too. But I'd like to add an element that I think is underappreciated of what actually caused this, we call it an epidemic, I think that's a fair statement. And that is expectations and metrics. Because about 20 years ago, there was a big push, pain is the fifth vital sign. And we put a number on it or a little kid, we put a smiley face on it. And the sort of advertising to us as well as to our patients. And of course, the rest of the hospital staff is, we can fix this. Turned out, we're not that good at fixing it and everything has a cost. And we were told it was going to be safe. I'll tell you one very brief story, a very well respected attending of mine when I was a resident laughed at me once because I had a woman with a forearm fracture and I wrote her a prescription for 10 Vicod, an opioid tablet, and 30 ibuprofen tablets. And he laughed at me and he said, you prescribed her more of the dangerous medication than the safe medication. And oh, how things have changed. You know, 15 years later, people look at the cross-eyed if I reversed it. So it's true. Although both of them have their risks. They absolutely do. They absolutely do both have their risks. But there are ways that we in emergency medicine can help to address this problem. And some of the things that we've done around the country involve buprenorphine. It's a long-acting opioid agonist. So it binds to the same receptor morphine does, the mu receptor. It doesn't bind particularly tightly. By that, I mean it doesn't bind strongly enough that it causes euphoria that leads to addiction. It doesn't bind strong enough to cause respiratory depression. It does work a little bit in terms of pain, but it's not a fantastic pain medication. But it's a very high affinity binder to that receptor. So it means it bumps everything else out of the way. It bumps morphine and heroin and Vicod and Norcohydrocodonoxycodone. It bumps all those substances out of the way, so it can bind to that. And so it's being used very effectively and is a first-line treatment for treating opioid addiction. In the emergency department, we've been very hesitant to use these medications for a lot of reasons. Some of them are myths in terms of what we can do legally in our departments. And some of it is our very reasonable concern for what we're going to do if we try to use this medication outside of the emergency department. It is possible, people say it's not, it is possible to be addicted to these medications to buprenorphine. It is very possible to overdose on it. It's harder to do, but you can do it. It's very difficult to treat it if you do. And so there are issues around using it, but I think here in Hawaii, it's not being used out of the emergency department. I think that's a next step. And it's going to take an effort to corroborate work with state officials to get the word out to providers in emergency departments, address patient expectations, work with hospitals, and address the communication issues that we've been talking about related to this medication. And ideally, you would initiate therapy and have a follow-up to plug them into. So that actually addresses the need for communication, the resource that is needed in the community. All of this is manageable. And as we were discussing before, even just an initial therapy in the emergency department is better than letting somebody sit in withdrawal. The problem is withdrawal is a huge driver to go use again. Exactly. And there are a couple of ways people have used this. You're right. The ideal way would be to give a dose in the emergency department. There are several algorithms now that have been created or guidelines or pathways that physicians can use that have been shown to be safe and how we administer this medication. The ideal situation is you pick the appropriate patient, you give them the medication, the emergency department, they feel better, and then you give them a warm handoff is what you'll see in the news where you don't necessarily talk to the place they're going to follow up directly, but you do have some way to communicate with them so they know this patient is going to be coming to them and you continue the pathway for treatment. So it's not just in the emergency department I gave you your dose and we're done. It's you're going to be going to this place for more care. Or worse, you're clearly taking too many narcotics. I know you're in withdrawal, but I don't have anything for you. That's sort of the guarantee of I'm going to go out and somehow get some narcotics. And that's kind of what we do now, right? People come to us for help and we can give them a list of community centers that will help them. We say take this and we hope it'll work. That first pathway I was talking about where you give them the dose of the emergency, Robin, a prescription for a couple of days, that'll double the chance somebody goes on to find effective therapy and is treated for their addiction. There's even a less aggressive way to do this too. Just a single dose in the emergency department has been showed to increase by 50 percent the chance somebody in 30 days is in a treatment program. Just to stem that initial issue they're having with withdrawal from opioids. And so these are things that we in emergency medicine want to make sure we're doing it right, want to make sure it's safe for patients. We need to communicate effectively with the state, with other facilities, without patient providers and treatment programs, but we need to put that together because it's an issue that we have to solve and we can be a part of that. I think it's an excellent project. It strikes me that it has the usual challenges. First of all, change is difficult. It's not a reason not to do anything, it's what we're struggling with on many fronts. And it needs implementation of a standardized approach, an algorithm, support from the state and the other providers and we need to make it happen. And there are actually a number of things like that. I know you're involved in some other care pathway issues because there's a guy named Deming, he's sort of this efficiency and quality guy. And his thing is unnecessary variation is the enemy of quality. And so if for example you do buprenorphone and I do not on the same patients, that's unnecessary variation. And one of us is right, in this case it would be you. So my quality is not as good as yours. The goal is eliminate unnecessary variation in the right way, namely pick the right pathway. And in the right patients, right? Of course. You don't get more, there's no more complicated industry than medicine. Sadly, everything has to be tailored to the patient, but once you find the right patient to fit in the right pathway, I absolutely agree that that is probably going to be the right way to do things in the most efficient way for the patient. Yes. And the key is unnecessary variation. As you said, medicine's complex. And figuring out which path, even if you have pathways for everything, which we have pathways for very few things. But even if you have pathways for everything, you still got to figure out which one's appropriate for a specific patient. Not the easiest thing in the world. In fact, that's often the hardest thing. Or in other words, once you know what's wrong, usually it's pretty easy to figure out what to do next. Until you know what's wrong, not so easy. Even so, it's something that we need to focus on. To me, this is one of the big topics of the era. And I do want to say, along the lines of the opioid issue and the buprenorphine issue, I think we have a very willing partner in the state right now with the Department of Health and the work that Eddie Mercer was doing. And it's an opioid initiative through the governor's office. They have been very responsive to these ideas that we have to try to do a good job with patient care and to listen to our concerns about other ideas that have come forward. So I like the work that's being done on the state in a very collaborative way with other physicians, hospital administrators and patient advocates who all come together and try to do a better job for the folks having trouble in our state. That's exciting. And it's, I think, an excellent project. And honestly, part of the issue with opioids is from the House of Medicine. So we sort of, well, sort of, we owe it to the population to help move it along and fix it. And that obviously impacts on the prescribing side. But it also is on the treatment side. In fact, you can't have one without the other. So I think this is a real project that is, emergency departments are patients with acute needs like, for example, narcotic withdrawal end up. And so we should be the ones who start the therapy. What else would you like to see happen over the next year? I think addressing those communications or continued efforts at addressing the communication issues we have in our emergency departments. And other facilities are finally jumping on board with this too. I hear hospitalists talking about the need to get information from other facilities and they're become more facile using the communication tools that we have now. We have a couple of different ways to access information, a couple of those that we described earlier. But we don't, we still don't have the way to handle this yet. We don't have the single source to go to. The repository is going to have all the information. And we shouldn't be blind. It's not going to happen any time in the suit. It's not going to happen the next couple of years. But we can continue to move the needle forward. And you start connecting these other pieces, hopefully a connection between the information exchange and the Hawaii Health Information Exchange, for example. Hopefully we can make that connection to more rapidly give information between those coming to the emergency department. And really, we should stop saying just coming to the emergency room. We should be saying those coming for acute medical problems. Or for that matter, just going to their own primary care physician. They should have easy access to the information that for the care that I provided in the emergency department too. And vice versa. So to me, that is the key issue in medicine right now is communication between providers in terms of what's been done for the patient and what needs to be done going forward. I think there are issues in how we document in those terms that we've all grown up with that need to change as well. So that's the issue I'd like to continue to work on along with these larger issues we talked about. And just to point out the obvious. In industries where the record is the product and banking is the perfect example. After all, if you make a deposit, the product is a different number in your account. Or if you make a withdrawal, and it might end up with a negative sign in your account. But anyway, that's actually the product. Our product is hopefully improving health. And it certainly consists of delivering care. But the record is separate and parallel. So when you said better ways of creating record or getting information into the system, that's a big challenge. And I'm hopeful that ultimately there are some seamless ways of doing this, but we're far from that. And or as a friend of mine says, and we won't use his colloquial expression. But in essence, everything I get out of the computer is great. Everything you have to put in, pick your own pejorative. But it's true. If we can get information either from the patient's past experience at our facility, or wherever else they've been getting care, it makes our jobs so much better. And our patient care. Our care is so much better. And it's even likely more cost effective. After all, if I know the result of a study that was done last week, didn't help figure it out last week, I'm not going to repeat it. I'm going to try something else. So that's great. Now, his complaint, of course, is trying to get what he did into the system, knowing full well that unless the next provider is back at this hospital, they probably won't be able to access it anyway. So that's frustrating. I totally agree. Yeah. So standardizing care, finding new aspects of things like acute treatment of opioid addiction and withdrawal in the emergency department, threading the balance between too much and too little, we'll have to have a future session for this. I think that just like unreasonable expectations kind of led the medical profession and our patients into the opioid crisis. I think unreasonable expectations are shaping some other harmful things. For example, the expectation that we can achieve 100% certainty in almost anything. Or I'm going to hand you a softball and closing. What do you think of that term rule out? Oh, gosh. Can't be done, right? No. And that's, yeah, you're right. And I think a lot of that, it starts with us as physicians and how we communicate with our patients and letting them know that nothing is perfect in medicine. We do the best we can and we have a lot of great tools, but there's always, there's always that chance we're not going to be correct. And doing more often does not increase and may even decrease the chance of getting the right answer along with other problems. Definitely. My apologies, everyone can lead to other problems. So we'll focus on, there, that's gone.  We'll focus on conveying the correct care and communicating the issues with our patients and making the emergency department the hub of diagnostics and appropriate acute therapies. And look forward to 2019. Thank you all for joining us. This is Craig Thomas, your host on Much More Medicine with Dr. Will Scruggs. Thanks.