Words at war Oh said week Dave said week that was what have I done now step in my office Well, you've done nothing except well congratulations on that fun to tell a killing story. It was good gosh Tell me Dave. How'd you like to cover the biggest murder story of the year? Oh brother? That's for me Okay, get packed. You're leaving for England to cover the war for the globe leave it. Don't start yapping. Thank you Listen to me. We caught short Wang Lee got hurt in a plane crash We need a matter we can trust over there and don't let it go to your head You covered a story over there the same as you do here just remember to be above it beyond it impersonal and impartial I catch just a guy holding a mirror up to light. All right cut the smart stuff Tell me what the job if the British don't object. Why should I? And that's the beginning of tonight's words at war as the national broadcasting company in cooperation with the council on books and wartime Presents an adaptation of Robert St. John's new novel. It's always tomorrow a hard-hitting book about the men and women of bomb battered England His lordship will be going to the country tonight, but he wishes to retain his suite very well, sir Name said week David said week. I've got a room Yes Oh come along then I have your keys all boy. Well, who are you?  Oh now look there. Take it easy kid. It's that English accent It kind of gets me down now. Suppose you tell me how I get started around here Well, first of all, you've got to get your ration books Then you'll need passes to get you by the armed guards at the Ministry of Information Uh-huh the war office in Whitehall BBC and other government officers Then you'll have to register as an alien an alien. Oh, yes. Yes, of course, you're an alien here, you know Then I'll introduce you to Michael Beckonist and try to get him to put you on his list for cigarettes Okay, okay, that's fine. But when do I get down to business? When do I meet church here? Oh, you don't all boy, but there's a cocktail party tomorrow Charities where you can meet some of the important people in the foreign office. Good context, you know good context Okay, I'll be there I Said a two-pinged in Tell me something what did you people think of the Prime Minister's statement that he doesn't intend to preside over the liquidation of the British Empire? Not very much. That's the kind of talk I like straight from the shoulder. What Mr. Thonsby What do you people think of the American ambassador? Well, frankly, oh man, it's too bad They sent him his wrong kind of chap, you know matter of fact, I'm quite disturbed or so, but the WWW menace the WWW yes, yes wine and Wallace and Wells Those fellas really are men as you know with their claptrap of brave new worlds and remaking the universe Socialism as well as you don't say oh most emphatically they talk of throwing open the colonies our colonists It's impertence my boy But it's been generous and kind to the natives in our colonies How would Africa or India or even America ever have been developed if it hadn't been for the British? We've used our skill and sunk our money into those obscure places to make them produce Why should we turn them over to backward nations at two pinchings? Oh, thank you so much. Oh, here you are. Sorry. I'm uh, I'm feeling a little sick. Oh Had one too many. That's right one too many. Excuse me, please.  No worse than the usual They're not kidding, baby. They take the cake every one of them. Excuse me, sir I said I agreed with you.  Listen beautiful. You're the only person I've met here today Who's made any sense right one genities. What's your name, honey? Here you are sir Look beautiful.  Yes, there is. How about having dinner with me tonight, sir? Well, it's a date. I'll meet you in the Piccadilly lobby at seven Okay, yank Okay What's your name honey poly poly what just poly What's yours? Dave Cedric Dave deal. Have you ever been to hollywood Dave? Oh, no. I come from Chicago Chicago I never heard of it Really David, you know, you look just like someone I've seen in the flicks ever so many times the flicks. Yeah, you know Flicks cinemas the movies Now don't tell me it was Carrie Grant. No, isn't he the stuck up one though Polly you're priceless. What are you doing in England, David? I'm covering the war for newspaper and I think you people are terrific I mean the job you've been doing. Yes And I think we've been taken in you've been What do you mean poly?  That's what I beg your pardon So would you and your friend mind moving to another table, sir? What's that way? No need to ask him, David Look around you Quite to see that all the lords and their ladies have left the vicinity of our table But why because they've spotted me for what I am a waitress I think I'm not good enough to be eating in the dining room with a savoy along with the likes of them Oh, you're kidding. Am I? No, I do you understand why I don't care who wins the blooming Blasted war My ration book and passes anything terrific happened today Oh, just the usual communique on the fighting on vile night's air raid No statement from cabinet members and nothing from Poland. Typical day What's the matter with you, Richard? You you look as though you just lost your last two bucks on the races David, I overheard some talk over at the ministry of information this morning. Oh, yeah, what about you? Oh, yes, they were talking about some girl who took the dinner at the Savoy last night Said she was a waitress What about it? Well Look here, old boy I've been over here several years and you can't find the face of convention like that or or what Well, you see said we England is a country with an upper and lower class Nothing you can do will change it taking that poor girl a girl to the Savoy with the same as Well as if you had walked into the dining room of the world office story in new york leading a horse Whose side are you on Matthews? Mine or theirs? The trouble with you as you've been here too long traveling with a lot of stuff shirts No, look here, old boy. No, you look here, old boy You tell your pals to stay away from the Dorchester tonight because dave said we're in his lower class girlfriend They're going to be there and tell them I said if they don't like it They can lump it Well, Polly, how do you like dining with the tufts for the second night in the row? Oh, I can stand it. Oh Oh You know Polly, I'm still hungry Serves you right for dining in such an expensive place all in all though. I I think the dollar limit per meal law is okay It's okay for those as obeys the law. Look around you david Do these people look angry? Well, do you want to know how they get around the five shilling limit per meal? Yeah, very much say that you and me are the likes of them We come here to the Dorchester and have some smoked salmon We order five shillings worth and then go around to Claridge's and have a bit of joint and vegetables Another five bob's worth. We just keep going from one place to the other So you see dave if you've got the pounds and shillings to eat out for six days of the week On sunday, you can spend your whole week's ration tickets for one grand meal Well, the rest of the people has to string theirs out for the whole seven days So that's what happens.  I suppose. Yes Well, my father lost his leg for democracy last time And what did it get in the privilege of stomping around on a wooden leg and selling violets to the rich Polly, if you feel that way, why do you wait on those people at Claridge's because I don't want to get drafted into the Rends or the 80s or a munitions factory. I'm not helping their blasted war along not me Polly, I don't get it. If you work for a hotel no matter what your job is It's called a reserved occupation and they can't draft you Nothing's too good for the rich, you know, you're bitter poly you're bitter and prejudiced Don't you realize what's at stake? Don't you know that the rich and poor in england are all in the same boat? Do you want to take a chance on the nazis winning the war? What difference does it make who wins the blasted war? The jetties won't scrounge me any worse than my betters have been doing up to now Does the Germans win? Let them win I'm sick of taking news handouts from government officials Let's go out and ask the people themselves how they feel about it. What do you say? Okay, David. Waiter the check The foreman said I could talk to you, may I? Hey, I think so of them all Now how many hours a day do you work in this factory at 12? How many days a week seven? But I hear we're going on sick soon. Tell me why Why are you willing to to work so hard willing? Hey, what's that? Are you bar mitzvim? I see one more question Don't you get awfully tired working 12 hours a day seven days a week? Oh, I don't mind that but the thing that plays me out is the four hours of air raid warden duty each night But after the war, I'll rest up It's a nice green sir.  Have you got any oranges? Oranges? Block me last time I saw a orange. It was on exhibition in region streets. It was five years ago What we'll have in that game, sir. I'll bet you will. Yeah, that's what we are fighting for, ain't it? What do you mean? Well, so all of us will have all the oranges we can eat, sir Yeah, and we will too right after the war That's what you might say, sir And how do you manage for food, Mrs. Thrunley? Well, sir, the rationing allows us each a shilling and tapence worth of meat each week Not a pound bone included Why that's 24 cents worth of meat a week American money How about things like butter and eggs? Two ounces of butter a week and one to three eggs a month depending on the season, sir We'll manage this as long as we have to There'll be tubs of butter and tons of eggs for all of us after the war, sir How do you feel about the taxes, your lordship? Texas? What does any man think about taxes? What father means is that he doesn't mind the taxes. Do you father?  Cedric I like to pay my taxes Every penny is a bullet aimed at the heart of the enemy. Would you mind telling me for publication? How much you paid last year, your lordship? Oh about $975,000 nine. Uh Gosh, you sure must have cleaned up. Well, as a matter of fact, mr. Cedric father only netted $24,000 There's a 97 and one half percent tax, you know, that's right My income was about one million dollars your money But what I'm giving to the war is nothing compared to what my son has sacrificed father my son lost both eyes in north africa Well I'm going to do my best to see that there's no recurrence of this after this war Stop it. David. Stop it. Do you think I'll believe the likes of him either? Oh, I'm tired of all this David I'm tired of your arguments tired of your flag waving.  You're twisted in your thinking If all the people I've interviewed felt like you england would have thrown in the sponge long ago Sure, there's injustices in england in america, too But do you honestly think you can wipe out those injustices of hitler himler and that gang got the top hand? do you Polly get into it and do your bit Then afterwards you will have the right. Yes, the duty to see to it that the upper crust listens to you Let them listen to me now. I say I don't want to live on hopes I say let them eat the same as we eat make the same sacrifices we're making Let them come out of the fancy restaurants and do their part and then I'll march into the nearest war plant and get a job tomorrow No, I'm tired. Come on. Let's be off. Where to? The Savoy not in your life. There's something more me own style the elephant and castle Well sit right down soldier what do you have jen and bitters if it's all the same to you sir Jen and bitters, please miss. Yes, sir. Pleasure is all mine sir. Hi, Albert Say, uh, what's this this uh cane and able business cane and able table Rhyming eh well give say something to me and well he went up the apples and pears And he sets down his cherry ripe on the cane and able says to us cows and kisses and where I'm around the ousers Hey now wait, wait a minute slow down. What in the world is that double top mean? That's quite simple Dave He went up the apples and pears the stairs and he sets down his cherry ripe pipe on the cane and able Don't tell me table right and says do we cows and kisses the missus and where I'm around the ousers There you are miss Thank you, sir Yeah, here's to Hitler's funeral I'll drink to that Where have you been Albert?  I can't nor fit Albert Oh, well, that's Dunkirk and this one's grease and creed and this is north africa This is Italy Now, I suppose they'll be pinning one on me for coming home to england Say, uh, what's the what's the medal for albert? That's for the pawn shop After the war poly oh, that's okay, Dave. I used to think the same as poly about those things and what's changed your mind play tell A handful of pretty colored ribbons Now you're willing to die for the empire a albert. I'm not dying for no empire poly What's the empire ever meant to me? I never got none of the benefits out of africa or india or egypt or palestine or malaya and hong kong or singapore We here in england pay as much for spices from india and rubber from malaya as you do in america Did you know that dave? No, I didn't albert. It's true. Of course. It's true. All right then. Who is it that benefits from the empire?  They are too right you are albert Oh, and I thought you'd gone and changed on me. Um, I have poly. I have How's that? Well, you just finished saying I wasn't doing any dying for the empire and i'm not going to What i'm risking my neck for is a better england after the war a good job Short on hours and long on pay decent living quarters a liberal government members of parlor do represent blokes like me And not just the blokes who live in the west end What's funny about that poly? What's funny? What guarantee have you got that you're going to get all of these things after the war? Where's your collateral? Who's co-signing this note for your future? The angel gabriel no Churchill roseville and starlin's co-signed my note for me poly. That's who And god blind me. They'd better keep their word or I'll Make trouble Me well if I were you I'd stick to the daily communique Find myself a sympathetic lady friend and have myself a good time while I was over here That sounds as if you don't expect me to be here very much longer. There's no room in england for idealists. Look dickie boy I'm no idealist. I'm a reporter. I sent the global story telling them what I saw and heard and then they all played safe Old boy stick to the daily communique don't be naive. Don't you know the truth doesn't always look good and print wait a minute Who says I have to print If I can't send the truth about the people Why not send the people themselves? Huh, I'll give it to me slowly sure look it's the little people of the world who have to fight the wars But if the little people met knew each other and realized that their common interests were tied up together They'd never be another war right right hold on a minute Statter a shipboat of english workers through a hundred american factories Let them stay there for the duration no speeches no propaganda no nothing just work How long would it take for the americans to find out that all englishmen don't wear monocles and spats? Send some to twight workers to england and the english would soon discover that all americans aren't jigglers Where are those cable forms? Um, who are you sending a cable to said week the globe The biggest story of the day By a press wireless by said london planned to bring about closer understanding little people britain The opposite numbers america today advanced in letter to british minister live Say what's this i just came to ministry and they didn't say anything about this he hasn't received the letter yet stupid i'm gonna write it after i file this cable This is their reply poly i got it this afternoon Have filed your tonight's think piece in waste basket stop You're not over there to solve england's social problems.  It's funny You know the people who run your paper are no different from those i'll wait on the clearages They all want to maintain the status quo Poly i moved out of the savoy today Why david To be near my new job new job Oh, don't tell me they've gone and sat you oh no no poly i'm still working for the globe But i've taken another job in a munitions plan have you gone balmy david now what you want to go and do a thing like that Because i believe in people like albert and you poly I believe in this war And i want to help our side out I've written and talked enough about democracy Now i want to do something for it And i want you to quit your job and come in this with me Polly this is a people's war with all of us fighting for something to believe in people's war What kind of people? Oh poly oh no when it ain't no longer a reserved occupation to serve tea and crumpets to swells on the daughter for And when they give us some guarantees for the future Then i'll join your bloody war, but not until Uh That was a close one You frightened darling Who me please take shelter in the cellar everybody.  Please turn off that anvil Breaking my head he's awake support his head nurse. Mr. Sedwig try to drink this please Ah there we are feel better now what Happened to me may i doctor yes certainly You were in a restaurant and so Sedwig you received a direct hit in the ribs eight days ago Three days Where's poly poly the girl i was with where is she What happened to her oh her she's okay as a matter of fact she's clamoring to get in here right now Look here old man. I want to get your story of the red. What was it like? I've had a dozen cables from home. I want to see that girl. I want Hello david Poly oh very well Sedwig i'll come back later You may have five minutes with him miss and then you will have to go. Thank you doctor Darling no no no no but supposing something could happen funny I'd accept exactly the same thought about you Me nonsense it'll take more than a direct hit to put little poly out of the war Or not tell me david What's wrong with you well i just woke up five seconds before you came into the room poly i I haven't had a chance you can move both of your arms. Can't you even though they're bandaged up right I think so how about your legs?  How's that? What's the matter david? poly I didn't feel it In that case we'll remove all doubts from the gentleman's mind by drawing honey Honey don't cry. Who's crying anyway? Oh david i'll love you. I'd love you if you didn't have any legs david. Thank you darling, but Not what's dropping you Well, I I don't know how i'm Going to be able to stand at a machine in that factory 10 hours a day Does it Does it mean so much to david? Yes poly It does then all right. Don't worry about it. I'll quit clarages david.  I knew it. I haven't changed my mind about the war Look david let's be honest with each other Life isn't no storybook I'm going to help out with the thing you want done But not for none of those hard high blown reasons you're always talking about i'm being honest david. I ain't no patriot But I am a woman and Well, I'm in love with you That's why i'm doing it Okay, darling Have it your way and another thing just because i'm working in a war plant don't mean nothing I'm going to keep an eye on certain people here in england just the same and you will help me david Yes, dear I'll help you and if they try us to cheat us out of anything we've won in this war Then we'll see if we can arrange another direct hit especially for their benefit Night words at war has brought you it's always tomorrow by robert st. John The radio dramatization was by martin stern and the cast included bill quinn as dave sedgwick Kathleen cordellus poly john stanley as albert and john morris matthews The music was arranged and played by william meter production garnet garrison Next week words at war will present the radio dramatization of borrowed night by oscar rave This series of programs is brought to you in cooperation with the council on books and wartime By the national broadcasting company and the independent radio stations associated with the nbc network


The study found that genes with a highly biased codon composition and characterizing a functional core in Escarichia coli k12 showed to be periodically distributed along the arcs, suggesting an encoded three-dimensional genomic organization helping functional activities among which are translation and, possibly, transcription. Additionally, functional classes of genes were also shown to systematically organize into two independent positional gene networks, one driven by metabolic genes and the other genes involved in cellular processing and signaling. These findings suggest that functional reasons may explain why genes are periodically organized within the chromosome. Furthermore, this study used a single genome analysis to generate new questions about the evolutionary pressures imposed on the chromosome. This article was authored by Anthony Maffolier and Alessandra Cobain.


Okay guys and gals, it's time to learn about one of the most interesting things that we have in this course And that is one of the best methods to market your products and your store today And I'm talking about none other than Facebook ads now if these couple of words intimidate you It really doesn't have to you don't have to be a marketing expert and you can definitely learn to do this and still Succeed while on a budget. So why Facebook ads? Well for one like I said, it's one of the best methods to market your store Your products or your brand that are available in today's online market small medium and big companies use Facebook ads to promote their businesses And it's simply a great way to connect between businesses and the right audience even while on a tight budget Facebook also has a really user-friendly platform to create and manage your ads You don't need any technical skills All you need is a Facebook active profile and Facebook is filled with massive audience data Including demographics audience interests and so much more another good thing about Facebook ads is that their ads are easily scalable So once you find an ad that's working well for you within one click of a button, you can scale it to the moon That's one of the things that I love about Facebook ads So you're testing several ads at once and once you find that winner It'll dominate all of those ads that didn't work well for you And it will make you some really great profit along the way So now that you have a whole bunch of information scattered in your head What exactly are we going to learn when it comes to Facebook ads? First things first you are going to learn how to create a Facebook page as simple as it sounds It starts by creating a page Next you're going to learn about the Facebook pixel and you're going to learn how to install it and embed it into your website And this will help gather audience data and audiences that are similar to them to find better Audiences that are better suit for your store and your products that you're trying to sell You're also going to learn how to research your audience Which means find the correct audience that are right to showcase your products to after that You're going to learn how to create converting video ads, which is a very important lesson Then you will learn how to set your campaign goals after that comes the advertising budget Which is important because you want to be on a budget and still succeed and I'm going to show you how and right after that You're going to launch your first ad after you launch it You're going to learn how to analyze the data so you'll learn about the differences from those that are not performing well to those that are performing well and Learn to multiply your success and learn from the mistakes of those that didn't perform well now I want you guys to stay super focused in this category of learning Facebook ads It's not going to be easy, but success is never easy I will take you step by step So you will learn all of the fundamentals and all of the important things that you need to know So once again, just take it step by step Concentrate stay with me and I'll see you in the next lesson where we are going to start by creating a Facebook page. See you there


So I know that one of Barb's hopes in inviting us all is that we would draw from each other And I can't tell you how beneficial today has been for me So if this feels like I've echoed everything that we've already talked about today It's as if you've written my slides for me So I'm going home a happy camper knowing that other people think the same way I do so For ten years I practiced at a large university setting in Western New York where we were the only show in town So if you needed genetic services, you came to me You saw me in the prenatal clinic. You saw me in the pediatric clinic. You saw me craniofacial team You saw me cancer and then two years ago I had this wild idea that I was going to leave a place that nobody ever left and I'm sort of glad I didn't know What I was getting into because I would have run the other way I am the sole genetics provider at an incredibly large Radiology clinic now when I start to tell you numbers It will blow your mind the number of people who are in line to see me And so as we've talked today, I think a couple of things have been helpful The first thing where Colleen said who needs my face and who needs my brain That's something that is just on my mind every single moment And when Laurie said well, do they need the genetic counselor or can some other technology? You know sort of take over so I may not have a ton of research to present But I would love to have you tell me what research questions you have Because after two years in this position, we have now gotten past the stage of I'm just dory and survive I'm swimming through my patients every day and now I have the go-ahead to say we've got enough control That we're gonna start researching these hundreds of thousands of patients a year So anybody wants to collaborate and come where it's cold. Let me know so We see the slide all the time But what I'm thinking about when I see this is when I was practicing in a university setting There was already some triaging happening the primary care physician the gyn Whomever thought they were a good candidate you plop me in the middle of a radiology clinic where everybody is just their general Population there's not a lot of triaging happening And so that's where the role of the genetic counselor has come into place is that many people don't want to go into that big Bad university setting for their genetic counseling. They wanted to bring the genetic counseling to the patient But it's created a huge numbers problem. So I work at Elizabeth Wendy breast care Which since 1975 has been this internationally recognized radiology center It is the largest freestanding breast imaging center in New York state definitely and in the US we see 200,000 patients a year like a fine-oiled machine It's shocking come in for their yearly mammograms their yearly ultrasounds and their yearly MRIs now if I'm being incredibly honest The reason that a radiologist said a genetic counselor is a good idea is the downstream revenue of an MRI right within their building So let's just get that right out there that that that was an important part of them So they're classified as a breast imaging center of excellence and there are seven bosses who decide what I'm going to do And what patients I'm going to see we have four campuses in and around Rochester I am housed at the main campus where we offer the following services digital mammography 3d digital mammography ultrasound MRI biopsies on-site bone density my favorite massage and then me cancer risk assessment and genetic counseling So today Generally, I just wanted to kind of say what are the benefits and limitations of being in that setting It often blows my mind how many people have really never heard of genetics I sit there and I kind of cock my head and go no one's ever brought this up to you before and then to just sort of say What are the beginning statistics? What have we seen within the first two years of implementation of this program? And then I would love honest to goodness to make my gray hair go away What are some ways that we could change the method in the protocol? Can I use that iPad that video that patient portal something that doesn't require my face and my brain because I can't do it And when you see how few patients I'm actually seeing in comparison to the volume Hiring a lot more genetic counselors isn't the key if we're only going to be little pieces of the puzzle So their initial program what they call the genetic counseling program began in 2009 It was an MRI nurse and a medical assistant who went for a little bit of training and we're told okay We're gonna have you order genetic testing specifically. They saw less than 25 patients within the year They did not do a great job and they still work there And they tell me they didn't do a great job of record keeping even knowing what they were talking about if they got a Positive they sent them over to me at strong where I did the counseling so they were just sort of haphazardly doing it In 2011 they hired a genetic counselor Who bumped the program up to about 200 patients per year now when I give you numbers in a minute You'll see how that's still very very small But what they did is at check-in when the patient walked in and filled out their health history form They took a little bit of family history and if that person was identified as quote-unquote high-risk They could see the genetic counselor. So it was based on a point system I can't get my brain back around how this was the best tool that they came up with But they did a point system where if you had two or more risk factors You were generated as high-risk and you got a high-risk letter the point system looked like this One point if you had any family member with ovarian cancer One point if you had a personal history of breast cancer after the age of 50 Two points if you were personally diagnosed before 50 and if you were Ashkenazi Jewish you got one point You can see there are so many holes with this and so many different ways What if there's a personal history of ovarian cancer you're completely missed, but they were attempting and they were trying the counselor that Created the system left after a year and lo and behold this position opened and I came in not knowing What a big deal this was going to be so in 2012 I started as the director of this program No staff. I answered my own phone. I made my own appointments I did all of those sorts of things and very quickly went. Hmm. This is bigger than that. So genetic counselor led expected to see nearly 1000 patients a year which is about 20 a week which isn't terrible in the grand scheme of things except It's only a drop in the bucket. So all patients continued to be actively screened at check-in We just started to do a better job of identifying who needed me and I'll show you pictures or The rubric in a minute, but the end of their session and this is the primary thing that I want to talk about It's a very passive aggressive The assistant tells you your mammogram for today was normal and oh by the way you answered some questions that tell us your High-risk if you want to here's the card for Jessica Here's her phone number caller if you'd like to make an appointment and that's stemmed a lot from a huge pushback from the Primary care physicians and gyns. Who are you to tell us that our patients are high-risk? They had a lot of issue with this, but the office decided we're going to identify you as high-risk We're going to tell your primary care physician and gyn that we identified you as high-risk This is the better implementation, but it's still a work in progress It's literally just lifting ncc and guidelines and if a patient answers Yes to any of those questions even one of them. They are deemed as high-risk now This is the blow your mind part of it Daily weekly monthly yearly the number of patients that come through the building daily is 500 per day for a mammogram It goes all the way up to a hundred and twenty thousand a year for mammogram The second column is the number of those that are flagged as high-risk and get my phone number 30,000 patients a year 30,000 patients a year Right now we have about a 25% flagged as high-risk that's too broad So we're working to make that smaller But right now the way we fish the pond to call people high risk It's 25% of patients if I'm only counseling five to eight patients a day, which is still up to 1,200 a Year I'm only affecting 5% or seeing 5% of the patients who call me less than 1% of the patients in the building who are called high risk So I sat with my radiologist recently and I said well even if we hired 20 more counselors We're still only going to see less than 20% of the patients We don't have an effective way in this system to capture all of those individuals I'm probably going to go off my slides separate from what I described last night simply because we've had such interesting Conversation, but here's the idea 25% of patients are identified as high-risk It's way too many right now the criteria is too broad But it also may not be capturing all of the right people affected versus unaffected patients And less than 10% of the patients are calling the genetic counseling and cancer risk assessment office I want to pause for a minute and say we were kind of talking about cancer risk assessment versus testing My experience is the exact opposite I am there for the purpose of a risk assessment of a tire acusic Who needs a management change to go get an MRI for my office? The testing is very secondary and I actually like that very much because they're coming for a risk assessment where the testing is really You know the sub-conversation that's happening Why aren't more people calling us and that's where I wrote Jillian's little slide down of is it because they're unaware Unengaged or they actively saying no and that's something that I've been trying to put words to so thank you for doing that There's a huge percentage of people who aren't calling and aren't coming in and why and I'll talk to what we've tried to do to up those efforts So why aren't they calling? What are the barriers? I've had more than one patient say to me They handed me a piece of paper told me everything was normal And I never even really read that I was high risk because it's just somebody handing them a piece of paper So in our office, we've done training for the actual medical assistant who's handing the paper that if you spend 30 seconds And have a conversation more than one patient said I threw my gum in it and put it in my purse I mean they weren't actually reading it and some people because they get it yearly every single time they come for an appointment Said oh you really meant it after you gave me the third one of those So they're calling years after the fact not right at the beginning and then should we actually be more proactive This is what I've spent the last six months talking about instead of just a piece of paper Should we do something where we're on the floor and at the time of their mammogram go down and offer a conversation You know today you had this high-risk category identified if you're interested we could talk to you about it while you're here We have a beautiful center where patients are there for three hours They're drinking tea and watching TV and doing all sorts of things as they're waiting for their results There's lots of pockets of time where myself or somebody trained could do consent could talk to them could do the tire Acusic during that timeframe. We are entertaining the idea of a waiting room with a monitor That has a little video of me talking five ten minutes of conversation A iPad you know bought for the waiting rooms where they can work their way through a tutorial So we're talking but we don't have an answer yet because 30,000 people have my phone number So we entered this idea of what I decided was essentially Group counseling, but I called it something else So I called it a monthly community lecture at the bottom of that high-risk lecture or high-risk letter Instead of call Jess and make an appointment. Hey, the next monthly meeting is at this time So it says for additional information Please consider attending one of these upcoming community lectures where our counselor is going to talk to you about this These have been raving successes We wanted to just for intimacy and conversation and I'm one person in a waiting room kind of having this conversation Keep it to about 25 to 30 people each time We've been averaging 50 per time and my secretary stay we closed down our entire lobby on a Monday evening once a month Patients sign up. They don't pay anything But they sign up just so that we have some accountability when they get there they check in I Lecture for 30 to 40 minutes on services what it is what I was hoping to do Was to weed out people that were getting the high-risk letter that didn't necessarily need me Instead what it's attracting is the people who need me the most and we're afraid to make that appointment So we've just started surveying those patients I don't have anything to tell you about it yet, but we've sent out surveys to each of them sort of saying What was helpful? Why didn't you come to counseling beforehand? What made you think that this was a better, you know atmosphere that kind of thing and at the end There's my staff my secretaries my assistants within takes willing to schedule people willing to take a family history willing to do this the risk assessment or the Tyra Cusick on the spot and sadly more than 95 percent of those people then make an appointment So it's not doing what I hoped it was going to do at all But I feel like they're better educated when they come in Interestingly, and this is where I'm going off the slides for a minute. I wrote myself some notes throughout today My time with each patient has gone down since I started the community lecture and since we've gone to panels We have this very thing very fancy thing called a dashboard where we have to keep track of 500 people in a day So literally they're moved throughout a screen telling you where they are in the bathroom They go to the bathroom if they're changing if they're doing this wherever they're going well It tells how long they're in a room with me So when I go to a waiting room and grab them I move them on the dashboard and say in with the genetic counselor So I have to the second how long I'm spending with individuals where it was closer to an hour before now It's that 35 40 minute mark So we're seeing my time frame come down because they've had some education ahead of time Which has been really interesting So again, if I'm thinking through on a nutshell 25 percent of our patients are high risk less than 10 percent are actually calling me of that 25 percent And should I be reaching out? This is where I've likened myself to Dory I don't have time to reach out to the individuals and the way I've sort of Solidified it for myself is that that starfish analogy right that I've sort of made a difference to that one and made a difference to that one I don't know how many more people we can fit within our protocol A couple of our doctors Have started thinking through Do they need to have me up front? Do you need to have me as a beginning part of the conversation and the consenting? Or is there ability to Have other individuals so one of the things that we've come up with with the help of some project managers and things Is this idea of a future workflow where while they're there? And they're gowned and they're waiting for their mammogram results or something through that process Could somebody approach them at that point in person instead of the piece of paper And what would that do to our uptake rates and those kinds of things? So this is just one idea um From 2011 to 2013 96,389 Health history forms were completed 24,000 were identified as high risk and 1,088 of them were actually seen So we're only getting about four percent of our patient population Seen in those 1,088 genetic counseling visits 80 percent of them pursue genetic testing And this is a highly motivated highly educated. They came in knowing There's very few people that are actually going to take the time to call me to make an appointment if they're not going to test Most of the time that 20 percent that didn't test I see large amounts of families together. We have a Easily four-hour geographic radius that come to our center So it's often moms daughter sisters group counseling. So even though it's 1,088 visits That's build visits. Lots of other people would have been present and part of the counseling Um, 664 were negative Those are the people I want to talk about for a minute because if I take those 664 of them go to the bottom here 464 of them were still eligible for MRI and that was the point of putting me within the genetic count or within the Um Radiology center was there are so many of our patients who still need to go on and get screening So we were able to track of those 464 how many went downstairs and actually had an MRI at that six month mark At that very first MRI six months after seeing me 54 of them had breast biopsies and 14 cancers were diagnosed right then at that very first visit To the radiologist that's so incredibly important because if they hadn't had that intervening Um appointment with me would they have gone on for an MRI? The other way that we thought about it is we did a retrospective review of two years worth of charts Of those 26,104 patients who were classified as high risk 2,149 of them came for counseling which was up to that 8 They can track that to when I came on board and the volume went up So we had a little bit higher reach rate if you will But what I am so interested in is why did 92 of them not do a thing? And going back to Jillian's idea they didn't know about it They didn't pay attention or it was an active. I don't want this service For some of the individuals were not actively capturing that they were seen elsewhere They could have gone to strong had the testing and just never reported it on that health history form And that's happened quite a bit And so we reviewed so far about 1800 charts of people who did not See me did not make any contact with genetics at all We're just trying to read into what's happening with them and we matched them to people who had seen me So we've got 1800 and 1800 There were 194 cancer diagnoses about 10 within that first two years So they got a point that was your diet. You are high risk Didn't see me and in those two years were diagnosed with cancer So we're trying to create something where we can interview some of those patients about what was it Um Ultimately what was interesting is how many of them had received the high risk letter one time versus two times versus three times There were patients that kept getting that information over and over and over again Um And then really interestingly and i'll stop here because i'm over my time We started to look at the pathology of it what percentage were invasive versus what grades they were Against other patients within our building as well And so patients would sought genetic counseling and had an MRI had earlier Diagnoses obviously than patients who hadn't gone and had that MRI in between So my real question is how do I keep up with this many people? Using technology to my benefit because they're not going to get my face and my brain and my mind all of them tired good Any questions for me you can think of um So being from the same area i kind of understand the patient population you're dealing with in the the catchment area is huge for Rochester um Do you get a lot of phone calls that you end up sending people to other places? Because that's why I knew where you worked is when you said sarah q's i said i know who you work for yes So um we get a lot of it has to do with insurance. We have a very odd insurance seen in rochester And excelus is one of those providers that makes it very difficult for us to test an unaffected patient When they're affected family member is alive. Not just did you appropriately counsel this person? but we must show documentation of estrangement or Refuse testing or insurance didn't cover for that affected relative And so we go to a lot of links to connect whole families, which is why they get referred to you as we're trying to figure that stuff out yeah Sorry if I missed this but for the I think it was 464 who needed an mri How many of them went for the mri? I saw the biopsy, but 464 I don't know if I have the number right this minute. It was 300 and something some 300 Because we have a tracking system with sort of a reminder That says this was recommended to you And then they check in about a month in advance if they haven't booked that mri yet With a just a friendly call of you should you know be booking this if you haven't But I mean that's a great example of what we've been talking about all day, which is a health behavior outcome based on genetic counseling Right, especially for the subgroup of people who did not need a genetic test or did not have genetic testing like You could just publish that and that would be extremely useful And we have an electronic medical record and a patient portal So every health history form for the last 20 years is part of it We have how they're reporting their family histories. What appointments they've been doing, you know The timing of those so we have all of that information. It's just how to troll it and get it and Make sense of it So I have a oh, sorry Go ahead No, I was just going to ask because you made the comment that you got a lot of pushback from the referring providers About putting that high risk Do you think that that has anything to do with some of the people not falling up at the person that's referring them? Absolutely saying well, maybe that's not really important for you Absolutely, because one of the things that we have two copies of the letter one that's in Physicians speak and one that is patient specific and we will often get a phone call from the patient Because the patient can opt out if they don't want to be called high risk or be To continue to get that high risk letter They can call our office and say please don't put me in that pool or notify me of my risk anymore And one of the things we ask is why and they will say my physician does not think I'm a candidate And at that point it's a conversation with a secretary, right of them saying my Yes In the last few months, we've started this program called the lunch and learn where I go into the obgym's office and just At lunchtime walk through and talk through why we're referring what we're doing. We do a lot of cases with them I'll go through cases from their own practice. Here's how when they came us ordering this This is what happened and we have all that data by referring physician So rob rested did a blog post about the angelina jolly effect and I was I was wondering if that Clear it and break you but my goodness I did not work the day that angelina jolly's story came out I was at home folding laundry and thought darn the sexiest day to be a genetic counselor and I'm not at work And my research question is whether it's for you or for the group If you were going to recontact those individuals who are diagnosed to sort out what may have led them to Not pursue the services. This is where the line of if you're conducting research and what kind of approval does that need versus You're just doing sort of a quality assurance for your employer I I would love some clarification about that and I just want to add one little asterisk to that Which is we have a huge cohort of people who had integrated BRAC analysis only and now there's a panel and our discussion is How many of those people do I recontact and say there's more testing? Do you want to come in and that's created a big issue for us right now And matt I feel like somebody should address your question a little bit I you should you should definitely if you're having questions that are IRB related talk to your IRB in your in your hospital But generally speaking so if you're want to if you want to do something for quality improvement And you're not planning to publish it and you don't intend for it to be generalizable You don't have to go through an IRB But if you think that the knowledge is generalizable you think you can do this and other people can learn from it And you want to publish it the IRB usually wants to see it. So that's sort of at least that's how the hopkins IRB Makes the distinction between research and not research But but practically the health system especially learning health systems are doing an enormous amount of quality improvement Research that they're publishing now. So Hopkins I think is a holdout a lot of learning health systems are just they just do it


And now, tonight's presentation of radio's outstanding theater of thrills, Suspense. Tonight, the story of two people and the terror that rolled with them in the city. We call it Backseat Driver. So now, starring Miss Vivy Janus and Mr. Parley Bear, here is tonight's suspense play, Backseat Driver. It can't happen to you. You read about stuff like that in the papers. These girls murdered and mutilated, drunks left dying in the gutter for the handful of change they had in their pockets. Loansome old men tortured because some hoodlum gets the idea they're misers with a pot of gold hidden under the floorboards of the shack. Sure, you know it's real, but it can't happen to you. Oh, you get your fair share of trouble. I've been a professional man here in Los Angeles for 20 years. I've met up with bums and grifters and petty sharpers. They're around in any business. But the viciousness, the real deep down dirt, that's for somebody else.  That's what I did that Saturday night. We'd driven all the way in from San Fernando Valley to Beverly Hills for a picture Ellie especially wanted to see. Wasn't that a good movie, Joe? Just the kind I like. Songs and dancing and girls in pretty clothes. I get so tired of cops and robbers. What's wrong with cops and robbers? Oh, you know what I mean. Murder movies, honestly.  The stuff those Hollywood boys dream of. You'd think the streets were knee-deep in blood and you couldn't hear yourself think for machine guns. Well, you get him first, honey. I don't think your door is closed tight, honey. Oh, don't forget about the gas. Oh, I got plenty to take us out the valley. I'll fill up at Bills. Remember how that song goes, Joe? What song? In the picture. You know, two on the moon, the one the boy sang to the girl. Well, that one, let's see. Oh, heck, I don't know. Well, we'll hear it again on the radio. How about turning it on? Settled K and X. We ought to get some news in a few minutes. I'd like to hear where they caught that fella. That murderer? Mm-hmm. They spotted him in LA this afternoon, but he got away. I know. You told us it suffered. Makes us shiver. Oh, don't worry. He won't get away with it. We left the lights of Beverly Hills behind us and I turned into Coldwater Canyon. It's as quick away as any to get us across the Hollywood Hills to the valley. It's dark in the canyon, quiet, with mighty little traffic at night. I flipped my lights up full and we swept up the side of the ridge. The news program came on, but I didn't pay much attention. The fella was talking about brush fires. They'd already put out the one near my place, though they were still patrolling it. We were over the ridge and sliding down to the valley before the program got to the part I wanted to hear. Oh, there it is. We put up higher on it. It's awful. Just awful. Not pretty, no. Somewhere around LA this minute. Hmm? You think it's right? I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. You think it's right us leaving Annie and Bud all alone? Oh, now. Well, and Annie's grown up and Bud can take care of himself. You can't wrap those kids in cotton wool. I know. I'm silly, I guess. Neighbors close all around, all they'd have to do is yell. Joe, what would make a young man do a dreadful thing like that? Could be a lot of things. Maybe he's got a screw loose, maybe when nuts over a girl. Maybe gets a kick out of killing like some of them do. You know all the answers. Hey, Joe! Keep going. Go on, keep going. I've got a gun here, I'll use it. You just keep going like this and no tricks.  I've had experience in these things. You are listening to Backseat Driver, tonight's presentation in Radio's Outstanding Theatre of Thrills. Suspense. For that phrase, Thursday night, hang on to your chair and bring in the whole family to keep you company because you'll want some people near you when the whistler comes around. You'll hear his mysterious whistle open the door to another mystery on most of these same CBS radio stations. And now, we bring back to our Hollywood soundstage Miss Vivy Janus and Mr. Parley Bear starring in tonight's production, Backseat Driver, a tale well calculated to keep you in suspense. I drove that car like we were skirting the rim of the Grand Canyon with nothing between us and the bottom but a mile of country air. This was it. The thing that happens to other people, to the ones that end up on slabs in the morgue, but not to me, not to Ellie. The first car we'd seen since we left traffic swooped down behind us. It passed, but not before the headlights caught our passenger clean in my rear view mirror. He was hunched forward, sitting on the edge of the backseat so as he could keep the gun rammed into the nape of Ellie's neck. He had light brown hair, pale eyes, and a nose that slanted. His mouth twitched, jittery. As the car went by, his eyes caught mine in the mirror and flickered. Keep your eyes on the road. Sure. Sure. Lose your hat. Right, boy. Like I said, you know all the answers. No, I didn't lose it. I stuffed it down a drain. Still wearing the blue suit, though. I figured it changed pretty quick now. I think yours will fit. You can have the suit and the car. Just let us.  Let's see if you can both be bright enough to keep your trap shut. Turn left on Ventura. Take the slow line.  I've been here before. OK by me. That's real wide-out. Straight out to open country, Mac. Then I'll take the Mrs. up on that offer to suit and the car. What happens to us?  What else? Play it safe and you ain't got a thing to worry about. Nothing to worry about. Once we got out into open country, we didn't have a chance of walking away from that car. All a murderer can hope for is time he doesn't leave witnesses around to get the law on his tail one second sooner than necessary. All I could do was stall and pray and make what feeble gestures I could at Lady Luck. The thing that came into my mind was so risky it brought my hair up on end, but there was a chance provided that trigger finger didn't start jerking. In the bright lights of the boulevard, I didn't think he'd notice, but a traffic officer would. I turned into Ventura and took the far lane, obedient as a whip pup. We must have made two or three miles before I heard what I was hoping for. What's that? An ambulance, I guess. There ain't no ambulance. It's a motorcycle cop. Joe, it's young Mike Kennedy. He patrols this place. What are you up to? What are you trying to pull? Nothing. The kid's a friend of ours. You think you can be easier? I want you. Listen, will you? The kid lives near us, practically grew up under our feet. All he wants is to pass the time of day or maybe send a message to our Annie. Yeah. I'll be dead. Keep your shirt on and I'll get rid of it. But buddy, it better be good. Kerb and Mike came up alongside. He sat balancing the bike between his knees and the grin on his face was a mile wide. It had worked. At least we were still alive and Mike wasn't two feet away. But where'd we go from here?  Good evening, sir. Well, what do you know if it isn't Uncle Joe? Something funny, kid? After all the times you've read us the riot act about observing the letter of the law. Oh, brother, we'd like to tell Annie. What's the matter with you, Mike? I didn't notice anything wrong. Hi, Aunt Ellie. Oh, nothing much the matter. Just Uncle Joe here proceedings to date lay out the boulevard with his headlights up full. Headlights? My golly, that's right. I must have forgotten to dim them. Now we ought to forget these things. Someday a big bad cop might come along and haul you out to the sta... Oh, hello. This is our new neighbor, Mike. Mr. Anderson. All right. Oh, glad to meet you, sir. I didn't know there were any vacancies out our way. Well, there weren't until recently. Mr. Anderson has taken the Charles Place. The Charles Place? You kidding? No. At last it looks like things got too much for old man Charles. He's clearing out for good. What kind of sudden, wasn't it? Yeah, I guess so. Oh, that's too bad. Pro man Charles, I mean. Mighty nice for Mr. Anderson, though. Good places are hard to find these days. All right, Uncle Joe. I'll let you off this time. Give my love to Annie. Mike. Yes, sir? Watch it, dude. Nothing. Come see us soon, boy. Always glad to have you. Oh, thanks. I'll be around my next night off. Got a date for Annie. That was that.  The chance had come and gone. But it felt to me like half my mind went off of that boy yelling at him. It must have been half a minute before I could pull myself together and ease back into traffic. Nobody said anything. I didn't dare to, neither did Ellie. I couldn't see her, but I could feel her holding herself stiff as a ramrod, scared even to turn her head. When two people have lived together as long as we have, each one knows what the other one's thinking. I went back to driving and praying. That and cutting my eyes up to the mirror, just in case there might be a white motorcycle eye following us. There wasn't, of course. In the back, I knew he was watching, too. Those flickering eyes darting like lightning between us and the rear window. The way I'd figured it, we'd started out with just about enough gas to get us back to Bill's station. When we hit that, the meter ought to show empty. The gas gauge was hidden from me by the rim of the steering wheel, but I was pretty sure I was right. I waited until I saw the red and green lights above Bill's pumps a block and a half away and then very slow and easy. I slumped over for a peek at the gauge. I leaned just a little too far. Sit up, bud. Sure. What now? What were you looking at? I was just easing the crick out of my neck. Yes, you were. You were looking at the dash. So that's it. Fresh out of gas. Now, look, I just remembered it. Don't give me that. You know it all along. From now on, you keep your hands on the wheel, Mac, but let me do the driving. So you know that filling station, get high-test gas and fill it up. Hi, Joe. Evening, Ellie. Hi, Bill. Good evening, Bill. Oh, evening, sir. Up to the top? Yeah. Apple. Apple it is. Here you've been to the pictures. Yeah. People know everybody in the whole valley. Well, we've lived here 20 years. From back when this was farmland, of course we know lots of people. I don't like it. Just get fired and get out of here. Make it five, Bill. Okay. Say I was up to Miranda's for supper. Yeah, right? Boy, her chili gets better every time. Don't see how it can, but it does. She's saving some for you, you know. Said you'd be around after the show. Oh, my. I saw Miranda this afternoon. Told her we'd be by for sure, Joe. Well, that'll be $1.50 on the nose. $1.50 and a half. Here, thanks, Bill. Well, same to you. What was all that about that Miranda stuff? Nothing much. Come on. Come on. I gotta ask you everything twice. She runs a drive-in up the road a ways. On show nights, we usually drop in for a carton of chili to take home. I just hope she won't call home when we don't show up and get Annie all worried. Wait a minute. Drive-in, you said? Yeah. And is Miranda gonna start checking on you? Oh, no, I didn't mean that. It's just that... She could call your Annie in between the two of them. They'd have the cops on a lookout for you before midnight. Oh, you're crazy. Yeah, like a fox. I ain't kept ahead of the buttons all this time by taking chances. We'll just pick up that chili, Mac. You want me to go to Miranda's? Why not?  I can cover a lot of ground before tomorrow morning. I ain't eaten so good lately. I could use the food, too. With you and a missus to front for me, what's to worry about? He was right about that. I went back to driving and praying. Miranda's plays one of those goldfish bowls, mostly glass, with light pouring out across the space marked for outside service. She saw us pulling up and grabbed a quart carton off the back shelf and hustled to the door. I was just saying to Betsy, better fix up that chili, Betsy. It's about time Ellie and Joe was showing up, figuring the distance from Beverly Hills. Oh, who's that in the back seat? I don't seem to recollect your face, young man. Though anybody will tell you, I never forget a face. Well, this is Mr. Anderson, Miranda. He just came out from the east. Oh, is that a fact? Say, Joe, you planning to go straight up into our home? Why, sure. Well, don't you do it. Go the back way, even if it does take longer. Of course, that brush fire between here and your place is out, but there are still 50, 60 men patrolling it. What's that? But that ain't nothing to what's going on further out the valley. That new fire's clean out of control, licking up hundreds of acres. They've been sending truckloads of firefighters past year all evening. Roads blocked for miles, they tell me. The road is blocked? For miles, they tell me. All them poor ranchers losing their homes. Being from the east, Mr., you wouldn't understand, but brush fires is awful things once they get out of control. Yeah, yeah, thanks. Joe, suppose we start moving, huh? Let's take the back way to your house. To our house? What say? You stay in with Ellie and Joe? Yeah, until I can get into my own place. What are we waiting for, Joe? Good night, Miranda. Well, goodbye. Be sure you come see me, Mr. Anderson. I'll be looking for you. It was. We weren't going to the country. We weren't going to be left to rot at the foot of a cliff or bury deep in brush. No, we were going home. Home to the kids, and taking a murderer with us. I still couldn't see Ellie, but I could feel her tensing up, tight as a pulled drawstring. Mr. Matric, you... didn't mean what you said, did you, about coming home with us? You know a better place I can hide out until the road's open? Well, it wouldn't be safe. We've got neighbors close all round. Nobody's going to see me. Nobody better. Joe, couldn't we go round the fire? Yeah, yeah, we couldn't. We could try. There are other roads through the valley. Now listen, Matric, we'll nose around and find a way through somehow. Everybody hundreds of acres burning firefighters' cops. Get off the highway. We're going home. No. No, I won't have it. Joe, you stop the car right here.  You heard me, Joe. I won't have him in my house, not with Annie and Bub.  But stop it, I tell you. It doesn't matter about us. It's the kids. I won't let him touch us. One more word out of you. Joe, stop! Now, don't say another thing. I'm sorry, honey, but it's the boss. We've got to do like he says. Yeah, that's telling her. Sure, you do like I say, and everything's going to be rosy. You've got no call to worry about. The kids, I like kids. As long as nobody gives me the brush off, we'll wake them up soon as we get home. You and his Annie can fix up a chili supper for us. We'll have a picnic. And as soon as the fire's off, we'll all take a trip to the country. Another picnic, huh? Yeah. It had to come to an end. I saw the bulk of the house looming up. There was light sneaking around the edges of the blinds up in Annie's room. She wasn't asleep after all. She'd been setting up in bed, maybe plaster and red stuff on her fingers and dreaming about the date with Mike. Bud's room was dark. He'd be wrapped in covers like a cocoon and dreaming... whatever boys dream, I couldn't remember. I pulled up to the concrete walk I'd poured with my own hands before there was any Annie or Bud. And then I cut the lights. In a second or two, my eyes got used to the dark. I could make out the high-hedge Ellie planted around the place and our roof rising up beyond it. Out, Mrs. Waste the house. Now you, Mac, slide out the same side, stand beside her. Oh, no funny business. I'm right behind you. All right, Uncle Joe. And Ellie? Ellie, you all right? All right.  There's nothing wrong with her. That's my girl. Well, just don't stand there. Help me up. Here. There we are. I've got to get in the house before the kids come busting out here. I won't have them mixed up in this. Well? How's he doing, boy? I got him through the gun hand and the right shoulder, see? Lucky shot, cop. You weren't lucky at all. They'd call me now. Maybe. Matrix isn't a good idea. Matrix isn't it, Uncle Joe? That's him. Miranda described him to you? The old girl doesn't miss a trick. She even knew you were taking the back way home. You left a clear trail, Uncle Joe. That slick work. I had to get him out of the car before the fireworks started. Ellie didn't stand a chance. She helped, though. Ellie catches on quickly. I'll bet. Mean guy like Matrix, you make him think you don't want him to do something, he'll break his neck doing it. I let on how I was trying to run out of gas and that got us to bills. I was made out there was no sense going to Miranda's so we get bold into going to Miranda's. It was a thousand to one. She'd run off at the mouth about the brush fires and scare him into hiding out. After that, all Ellie had to do was turn on the hysterics. He was dead set on coming here. Yeah, yeah. Bright boy, like I said. Yeah, bright enough. You did all right, too, Mike. I was watching the rear view mirror all the time you were trailing this, but you never showed. You knew I was there, though. When one officer starts double-talking another officer, he wants to know why. I said a thing to him except that I'd bought some place out here. Yeah. The Charles Place. Poor old man, Charles. In a tough spot. Moving out for good. What's wrong with that? Matrix, didn't anybody ever tell you it wasn't smart to take up with strangers? Maybe I'd better introduce myself. My name's Charles. Joe Charles, detective, homicide. Tonight I was off duty, just taking my wife to a movie. Suspense. In which Mr. Parley Bear and Miss Vivi Janes starred in tonight's presentation of Backseat Driver. Next week, the story of twin identities in crime. It is based upon fact. We call it The Greatest Thief in the World. That's next week on... Suspense. Suspense is produced and directed by Anthony Ellis. Tonight's script was written by Miss Sally Thorson. The music was composed by Rene Garaghan and conducted by Wilbur Hatch. Featured in the cast were Larry Thor, Tony Barrett, Jack Edwards, Joe Pranston, and Helen Pleath. Thor's Address is the CBS Radio Network.


I'm somebody who relapsed many times and this is something that a lot of addicts trying to get clean actually go through and when I was trying to get clean I just I couldn't understand I couldn't understand why did I keep relapsing and for loved ones of people with addictions it's even more confusing right they go off to rehab you think that they just get fixed up come back so that relapse after treatment is so weird and confusing and sometimes we get angry and upset well in this video we're going to be talking about Chris Offling going back to treatment but we're going to see what we can learn about this. What's up everybody this is Chris from the Rewired Soul where we talk about the problem but focus on the solution and if you're new to my channel my channel is all about mental health and addiction recovery and what I try to do usually to try to teach different lessons to see what we can learn from is I'll take different topics going on in the YouTube community because I don't know for me that's an easy way to kind of grasp the subject so if you're into that stuff make sure you subscribe and ring that notification bell and if you're not yet make sure you follow me on Instagram and Twitter at the Rewired Soul all right so yeah Chris Offling I think that's how you say his name if I'm saying it wrong feel free to correct me down in the comments below but anyways he he's somebody who I had no clue about but he was brought to my attention a few months ago or maybe two months ago whatever he posted this video it's a it's called I'm a heroin addict the truth about everything so I had some people send me that video and see if I would do a video about it and I didn't end up making a video on it but basically in it Chris discusses his heroin addiction he talks about how he went to treatment talks about you know that's why he's been you know away for a while and he's trying to focus on himself he's trying to focus on his recovery and everything like that it was a great video and I'll link it down in the description if you want to check it out right so anyways whenever I see somebody you know get clean like because my drug of choice was prescription opioids so although I didn't progress to heroin it's the same stuff just in a different package all right but whenever I see somebody getting clean especially like on YouTube I follow their progress like some of you have seen the videos I've done kind of looking at Taylor Nicole Dean's addiction recovery and by the way she just tweeted out today that today she celebrated six months clean so that's awesome and yeah I made a video yesterday you can check out about her trying to get off some boxing all right well anyways I started following Chris on YouTube as well as on Twitter and I saw today that he popped up with this image and it said the hospital has a no phones or internet rules so I bought an Apple watch to sneak in so I could write you guys but if I don't tweet or respond to your text you know why so at this point I didn't realize he went back to rehab like I saw that and those of you don't know me by the way not only did I get clean seven years ago but I worked at a very very large addiction treatment center for a few years and I ran groups I met with clients I've literally worked with thousands of drug addicts and alcoholics all right so when I saw that I'm like okay did you go back to treatment well the tweet right before that or a couple tweets before that he talks about how he was going to a detox facility and that's awesome like first I want to give Chris praise and anybody out there like check it out like never give up like never give up like I said like I have seven years clean and I was a chronic relapser I have met so many people like one of the reasons I didn't give up because I met so many people who relapsed multiple times and then something clicked and they managed to stay clean like I have met people who relapsed like 10 15 times and now they've been clean for years so never give up so whenever I see somebody like Chris going back to treatment I'm like that's awesome that is freaking awesome but like I said in the intro we get confused we get confused as to why we relapsed and when I saw this when I saw him saying that they don't allow phone so he snuck in an Apple watch I'm like brah right because my videos are for all of you all right so so one thing is and I don't I don't blame Chris too much for his somebody trying to get sober and stay sober but when you have this kind of massive influence like he's like hey everybody you go to rehab sneak in an Apple watch that's a way to do it right so I'm not a huge fan of that but I'll give them a pass on that but my videos are for you whether you're trying to get clean whether you're in recovery whether you have a loved one all right so like here's the thing like when I first got sober like every every time I got sober every time I got sober I kept doing things my way right I kept doing things the way I wanted to do them and I kept relapsing so finally seven years ago seven years ago when I was when I finally just threw my hands up in there I'm like I have no idea what the hell I'm doing I can't stay clean in fact Chris's next tweet after that Apple Watch one says every day I say I'm going to stay clean and it's all I could focus on I need to give myself credit for getting off anxiety meds and away from bad friends absolutely by the way but the painkillers I can't do it alone for some reason wish me luck all right so I couldn't understand why I kept relapsing but it was because of stuff like this people would tell me what to do and I'm like I know a lot better than you right so I got clean I didn't actually have health insurance or any money or anything like that to go into treatment so I was very fortunate that my mom put me in a sober living and she paid for my sober living mind it was about five hundred dollars a month but in that sober living and I was a 27 year old grown-ass man they had all sorts of rules all sorts of rules if any of you have ever been to sober living typically like you'll you could probably relate to this usually there's a blackout period where you're not allowed to have your phone or you know whatever it is and that's for a variety of reasons like they don't want you texting your dealers and everything because when you first get clean you're still just a wildly crazy person especially if you're withdrawing like you want to you want to score right but anyways they also want you to focus on yourself so like for example the treatment center I worked at there was a seven-day blackout period where like when they first came into inpatient treatment we locked their phones in a safe but after a week they were able to make phone calls back home and things like that but anyways there's all these rules and I didn't want to abide by them I did not want to abide by these rules right but like I said I had this gift of desperation and something in my head clicked it's like Chris when you do what you want to do you end up relapsing all right so when I see this when I see this young man who had the courage to go back into treatment and he's like haha I snuck this in I'm like no dude like this is something that I watched happen so many times and let's talk about this so real quick I just finished this amazing book by an author by the name of Dan Ariely like if you're into human behavior check out all the Dan Ariely books right but I've just finished this book it's called the honest truth about dishonesty plenty of studies in there like this dude he just does a billion studies and it helps me kind of understand like this is such a great book I think it should be mandatory reading for anybody newly sober right it explains how your lies and dishonesty can snowball right so when I was working in the treatment center we had a no cell phones policy so once they went from inpatient to outpatient they would get their cell phones back but the rule was you couldn't have it during sessions right during groups during individual sessions all that stuff you cannot have your cell phones so every morning like I would do morning groups there and I would go in there do group and then this tech would come in and he'd have this like low like safe suitcase type deal and okay just picture this we have like 60 to 70 people right in the group and he'd be like okay everybody put your cell phones in and there were so many times so many times you get like less than 10 cell phones in there right I would just laugh I'd laugh I'd be like okay all right it's you know it's just nobody has a cell phone none of you guys have cell phones okay you know whatever but here's the thing and I tell people straight up like I do not care I do not care like if this dude Chris if he was in my treatment facility I'd be like I don't care dude I don't care and here's why when I was getting sober and my sponsor sort of gave me giving me directions and things like that or whatever I'm the type of person where I want to cut corners I want to do it my way oh you want me to do all this now I don't want to do that right and then I just sat there and I thought about I'm like okay if my sponsor tells me to do this and I don't do it who's that hurting right because in our mind we like to think like I'm getting away with this right but my sponsor is sober as hell he has an amazing life and then I'm sitting here in a sober living house with no friends no family no money I have an oxygen tank and I'm thinking about how I can cut corners I realize that if I don't do what I'm told the only person I'm hurting is myself so when I was working in treatment and I saw people like thinking they were being all sneaky hiding their phones about turning them in like I remind them of that I'm like listen like this doesn't hurt me like I'm cool like after every day after I did groups and put in my hours I got to go home I got to go home and I celebrated one more day clean right so whether or not they had their cell phone on them made no difference to me and I'd remind them of that right because why do we go to treatment why do we ask for help why do we reach out for help right I'll tell you because our life sucks all right chances are Chris is in the same position where he's having issues with friends family members all this up some of you might be able to relate to this right so why do you go to treatment to try to get some of that stuff back so we got to check our priorities man like what's more important like trying to figure out a way to save our own lives or talking with people on you know Twitter or on social media right I saw people lose their minds I need to be able to call this person I need to be able to call that person all these other things I'm like no no no no no no you need to focus on your recovery like we need to get our priorities straight like think about it if you can't go like a week two weeks whatever it is or just even a few hours without your phone without your technology like how the hell do you plan on staying clean in this crazy world where we're surrounded by triggers on a regular basis but the last thing I want to talk about too is something one of the studies in there about the from the honest truth about dishonesty is this snowball effect right so like I'm the type of addict and you might be able to relate to this I'm the type of addict where if you give me an inch I'll take a mile right it's still something that I work on today in with other vices in my life right like I'm for example like I'll be dieting right and I'll be like I'll just have this one piece of chocolate the next thing you know I'm just like whatever I screwed it up I'll just keep doing this right it's the same thing when we lie right so like these little things like when these clients would keep their cell phones in their pockets and stuff I would tell them that chain of events what happens is like ooh I got away with putting this cell phone on my pocket nobody knows I'm such a badass right and then it turns into ooh you know what I bet I can skip this group and not do this I bet I can get away with that right I'm so badass and they can't catch me you know and then that ego starts building up again and then next thing you know we're talking about how we could sneak drugs in there or we could probably use like it was no coincidence that the same people who were breaking these small rules were the same people who thought they were gonna pass the drug tests and treatment and they got caught you know what I mean because our brain tells us that we're hot stuff we could just get away with it anything right so anyways I'm going on way too long I thought this video was only gonna be 10 minutes but like I hope the best for Chris and Chris if you ever see this when you get out like feel free to reach out and all of you out there feel free to reach out to me if you need to talk or if you have a loved one right like I'm not a therapist or psychologist I am somebody who has not only stayed clean but I worked in treatment doing kind of like peer support and sharing my experience and a lot of the experience I share is based on not only my own but what I've seen happen to others all right but the last thing is even if you're not in recovery keep your eye on the prize all right and for us for people like me that prize is staying clean for you it might be overcoming your depression overcoming your anxiety whatever it is all the other stuff is trivial nonsense and if that can lead you back to that dark place where you don't want to be then stay away from it all right but anyways that's all I got for this video if you like this video please give it a thumbs up if you're new make sure you subscribe and ring that notification bell and a huge huge thank you to everybody who supports the channel over on patreon as well as everybody who supports the channel by buying my mental health books at the rewiredsoul.com and buying different merch like this shirt with my adorable kitty Maya on it all right thanks again for watching I'll see you next time