Buying Time

“Thank you for buying us the time to say goodbye.”

No one had ever said that to me before, and I wasn’t sure how to respond. My patient had just passed away at far too young an age. I hadn’t been able to diagnose the problem killing them in the brief time they were my patient, and the ICU team couldn’t help either. The only thing any of us had done was crush bones inside a chest during CPR, place lines and tubes into a lifeless body, and pump a fading patient full of fluids and medications in a desperate attempt at keeping the heart beating . . . for another twenty hours.

Twenty hours.

From the time the patient arrived to my emergency department until the very last heart beat, less than a day passed. It was just long enough, apparently, for the family to come from all around the country, and say goodbye.

We had bought the family time to say goodbye. That was all.

Those words stuck with me. “Thank you.” Thank me? For what? In my estimation, I had failed. The patient died. It’s over. I’m not even sure their goodbyes were heard. Don’t thank me. And “buying time?” What time? Twenty hours? Twenty hours after only less than forty years – the last three of which were spent in agony, fighting desperately to overcome a raveging disease, and losing every day. What time did I “buy” this family and their beloved lost? And how much is twenty hours worth, anyway?

“Thank you for buying us time.”

Those twenty hours were – apparently – priceless.

That moment stuck with me for a while. And I began to wonder: if time was all this family wanted, after decades of experiences, things and memories, what would my own family say one day when it’s all over for me? Will they ask for more time? Will I? And, if so, how can I get it?

I enjoy finances. I read about retirement strategies, interact on blogs and forums with others and debate tactics and ideas, I even manage my family’s retirement investments on my own, for better or worse. One of the themes I come across often when interacting with the professional/financial world is the perpetual drive that so many have to stop trading time for money. They treat time as a commodity that has value all it’s own, and want to find a way to protect and save it as if it were currency.

And, in a way, it is.

Like many who are attracted to good fiscal management, our family has a budget. Periodically, my wife and I review our spending, discuss our financial goals for the future and assign a certain amount of money to each category of spending we have in an attempt at creating a system built to help us meet our obligations as well as achieve our desires. It keeps us on track. It keeps us focused.

We have no such budget when it comes to time, and I suspect that most are like us.

Time is finite for each of us, that much we all know. We can’t know how much of it we will have, but we each know that someday we all will run out. For some of us, it will be sooner than we expect, or want. Lately I’ve been wondering, how would my “time budget” look if I were to write one out?

When I think about the time I spend in a day, and how I spend it, it is interesting to me to try and see where I can find more. Where I can buy it back, if you will. Some things in my life are basically mandatory and can’t be changed – at least not without repercussions or consequences I’m unwilling to accept. Sleep, for example, is a time consuming activity that I refuse to concede. I spent enough years during a combination of my education, my training, and the vigors of youth giving away my sleep in exchange for more time. I’m done with that now. Sleep is precious, and I will hold on to it to the bitter end.

There are other parts of my life where the time it takes is the time it takes, and I can’t adjust the numbers. A daily shower, for example, would afford me another 15 minutes a day, should I forgo the event. But I’m not sure those 15 minutes would be spent with anyone I cared about when you consider the stank that I’d carry, so it needs to stay. Eating, brushing my teeth, and pretty much all aspects of personal hygiene are included in this category of “don’t adjust.”

But, much like making a personal budget, my day/week/month/life has many areas where I can make reasonable changes and find much more time to devote to those things that I feel a desire for, rather than simply a duty toward. So, I decided to take a look at my routine and find the places where I can create time for myself, and in turn progress toward achieving the goals important in my life.

If you’re anything like me, these four places are probably big time wasters, and just the tip of the iceberg:

  1. Social Media

I spend a lot of time on social media. Added up, I’m sure I spend more than an hour each day scrolling feeds and watching videos. Facebook, Twitter, Instagram, YouTube, you name it. Some of my engagement stems from a genuine desire to keep up on news and current events, to see how my friends and family are doing or to keep this blog going and interact with those who read it and to encourage more to do so. But much of it involves looking at memes, gifs and pics that don’t have anything to do with anything related to my life. Worse yet, I’m a debater, and I find myself engaging in debates over health care related topics, political topics, even sports topics. This is time lost, and provides me with no meaningful content for my life. In all, I’m sure that I could spend no more than 20 minutes per day perusing my social media accounts and achieve everything I wanted or needed to both personally and professionally.

facebook pie chart
I love this meme. So true…

Time spent: 60 minutes/day

Time wasted: 40 minutes/day

Alternative activity: workout 40 minutes/day


  1. Television

I love Netflix. We all do, right? Who doesn’t love having a plethora of entertainment and time consuming media at your fingertips constantly? And it isn’t just Netflix, but also Hulu, Amazon Prime, YouTube and Vine that give us the ability to no longer feel awkward in an elevator or on a bus. Neither eye contact nor conversation with actual humans need burden us when forced to be amongst people without any other clear direction or planned activity. Insomniacs no longer are aggravated by only infomercials and reruns of MASH available to them in their hour(s) of desperation (though who doesn’t want to watch MASH, really?). We can binge watch shows we never knew we liked and angrily lament the fact that Stranger Things likes to wait an intolerable amount of time before they release a new season simply because they like to torture us.

But remember when “binge” was a negatively associated word? Binge drinking, binge eating, binge and purge study habits – all generally accepted as sort of a bad idea. But binge watch? Let’s do it! I would estimate that I spend at least 10 hours per week watching some sort of media entertainment – much of it alone.

Throw cable tv and sports into this mix and you’ve got a number probably nearer 14 hours per week. And much of it is spent alone – not watching movies as a family in a relationship building setting.

Nevermind that an iPad and Netflix have literally become babysitters in my home. Even as I write this, my two youngest are lazily lying on the couch next to me on a rainy Saturday morning – each with a Kindle in their hand and videos mesmerizing their minds.

Fourteen hours a week is more than sixty hours per month, or seven hundred thirty hours per year. That’s thirty days.

I spend a full month each year watching television of some kind. Looking at that in numbers, I just threw up a little bit in my mouth.

Time spent: 14 hrs/week

Time wasted: ??? at least half ???

Alternative activity: practice guitar 1 hr/day (and get pretty good, actually), cancel cable and Netflix altogether and go to the movies with my kids once a week


  1. Driving

I met a doctor once who worked in the same ER as me. He had left what was sort of the Holy Grail of hospitals in our group to work at my shop – a nice, but generally less desired place where patients weren’t quite as sick and pay wasn’t quite as good. I asked him one day why he’d done this. He told me that “every day, I would drive past this hospital – which is 5 minutes from my house – and get onto the highway heading to my then hospital which was about an hour away. My wife was battling breast cancer at the time and things were just really stressful, and one morning I thought to myself, ‘what the hell are you doing? You could stop all this driving and be home more.’ So I did.”

Happy to be done with this life…

Remarkably simple, huh? (This is also the guy who told me that the one piece of advice he had for being financially healthy was to “buy a smaller house than you really want.” I’ve remembered both the lessons and have come to appreciate the wisdom with time.

Now, commutes are tricky. Sometimes we can’t control them. Not all of us have the luxury to choose where we work and make sure it’s within close proximity of our home. Many of us have to drive a lot for a living and may even feel like we live in our car. But many of us don’t. And would you believe there are actually studies that show there is an inverse relationship between length of commute and overall happiness. One study even suggested that cutting your commute may be the equivalent of getting a $40k raise! Now I don’t know if I hate driving that much, but it’s an interesting notion that we are happier the less we are commuting to work. Seems to fit my personality, at least.

As you’ll see in an upcoming post, my family and I recently relocated 500 miles to be closer to home. With that move came a massive change in my commute. My friend’s words resonated in the back of my mind as we considered whether or not to uproot to a place where I’d make less money. There were many factors in the decision, but one of the big bullet points for pulling the trigger (how do you like that play on words?) was my drive to work. Previously, I was driving 50 minutes door to door down a long stretch of highway. Often annoyed by traffic and exhausted after a shift, there were many times I would pull off the highway after a night shift to catch a nap on the access road. Pathetic, I know. “What the hell am I doing?” was uttered out loud several times.

With my new drive, I spend a maximum of 15 minutes on the road, and never touch a highway. It’s such a mental relief to know that I can leave 30 minutes before my shift and not worry about traffic conditions and know that I’ll have time to stop for a soda or gas if I want, and still be early.

By the way, I went from the guy who stretched his time at home as much as possible so he would walk into work exactly on time to the guy who still has time with family at home and gets to work ten minutes early. And, as any ER physician would tell you: the latter guy is the best partner to have. When it comes to the ER, if you’re not early, you’re late.

Other examples of how I’ve tried to cut back my driving time:

  1. Request more tele-meetings or phone conferences
  2. Choose leisure activities close to home (like golf, in my case)
  3. Avoid peak times to run errands

We all can’t limit our driving as much as the other guy, but I’m sure we can find time to decrease it here and there, which could make a big difference in your day, and overall. level of happiness.

Time spent previously: 100 minutes/shift, 16 shifts per month = almost 27 hours/month

Time sent now: 30 minutes/shift, 16 shifts per month = 8 hours/month

Time saved: 19 hours/month

Alternate activity: sitting with my family and relaxing before a shift – truly priceless!


The housework will always be there, so fish while the fish are biting!
  1. Housework/projects:

Ray Anderson and his pocket brass band would implore you: don’t mow your lawn (but make some wine from that dandylion). I’m not sure I’d agree not to mow it, but unless you actually like to push around a two foot blade spun by a go-kart motor in the dog days of summer and finish your afternoon covered in a mixture of sweat, dirt and millions of grass clippings, I’d say you probably shouldn’t mow it yourself.

I used to be the guy who liked to mow. Truthfully, I never liked it much, but I thought that since I was the “man” of the house, a homeowner and a tough guy that I was supposed to say I liked it. Then one day I was pulling out of my garage into the 100+ degree heat and telling myself that when I returned from work that day my amazonian rainforest must be tackled, when I noticed that my neighbor’s lawn guy was starting in on the next door lawn, which was in need of a trim but still half the length of mine. Something compelled me to stop. In a moment, nearly all of my chauvinism flew from my body like a summer-led exorcism. Before I knew it, I’d negotiated a measly $20 per week to mow my lawn on the same day my neighbor had his done, and I haven’t pushed a mower since.

Now, I know what some of you are saying: “but I really do like to mow!” That’s great, go for it! If my wife would let me put a zero-degree turn, 60” deck riding mower with an mp3 port and a cup holder and cooler, I’d be out there working on my farmer’s tan with a smile on my face and a beer in my hand, too! But, as I live in the real world, I’m finally comfortable enough to admit that I hated push mowing my yard, no matter how small it was, and am happy not to be doing it anymore.

*Note, this post was started prior to our big move, and I now live on 8 acres and have purchased that amazing 60″ mower. My wife and I now fight over who gets to mow each week, and we’ve embraced the summer sun. (yes, it has a cupholder, too) I decided to leave this part in, however, because I still believe it’s more economical to have your lawn mowed when you can, and certainly would save you time. But, I have noticed that my time spent listening to audiobooks on Audible has grown exponentially now that I have a couple hours each week to spend sitting on the mower and enjoying a sunny day in peace. Still better than my big-city commute!*


The point here isn’t that mowing is bad, but rather that there are plenty of things we “occupy” our time with around the house that is probably not something we enjoy, or really need to do. Some of them can be delegated, such as mowing, house cleaning, painting. Some of them are things that just don’t really need that much attention. For instance, will it really kill you if you don’t have the prettiest yard in the neighborhood? Why not go throw a football with your kid instead of placing another round of fertilizer down this weekend? I’m a big believer in learning how and teaching your children to change a tire or the oil in your car, but when they are too young to help, why not let a professional do it so you have time to spend with your kids instead? Are you staying up all night in the garage because you “have to” get that washing machine up and running, and your wife went to bed alone again? Call a repairman to do the work and make room for some marriage building time.

I’ll admit, this subject is a tricky one. Because, as I mentioned, another thing besides time that is finite in our lives is money. So, I’ll give some leeway here and suggest that some of these cases would require trading in the time used on the task for time spent generating income to pay for the conveniences you’ve just welcomed into your life. But many of the things we do and refuse to delegate out are a) relatively inexpensive when compared to our time-for-money earning potential, and b) may actually save us money in the long run (think operating costs for lawn equipment, fertilizer, parts for repairs or needing to redo the work over and again vs getting it done once time the right way).

There’s no hard or fast rule about what you should or shouldn’t do on your own vs delegate or simply forget about. But, I think it’s safe to say we all take on more than we should in the category of projects and housework, and could find ways to create room in our time budget with a little bit of willingness to let go of a bit more control.

Time spent: unclear, but at least an hour a week mowing in the warm months

Time wasted: half of it if you consider it may take me half the time to earn back the money I just spent by delegating the task

Alternative activity: sipping a margarita on my back patio with my wife, marveling at my well manicured lawn as my kids run through the sprinklers over it

It’s easy to lose track of wasted time. We all have interests and habits which at moments of weakness or distraction may occupy us at length before we realize what’s happened. And, it’s easy to trivialize a minute here or an hour there as we go about our daily lives. But if we look at time as we so often do money, it becomes obvious just how wasteful so many of us are. When we reach that realization, we can begin to organize our lives to respect time and to afford it the value it deserves. And so often it only takes small changes to add up to big savings. Like many of my unfortunate patients who would’ve wished for more precious time, or their families who appreciate every little bit extra they can get, we should learn to hold dear the time we’ve been given, and strive to spend it as wisely and as productively as we can.

Because, eventually we will all run out of time.

And contrary to what we may like to believe, we cannot buy it back.


What do you think? Are there areas of your life you’d like to trade for more time? Have you already made changes? Comment below…

Thanks For Reading

The ER Dad

Big Bad Beards and 5 Reasons You Gotta’ Have One!

It’s Labor Day Weekend, and you know what that means? It’s the ceremonial end to another great summer. Fall is nearly upon us, which means college football, one last camping trip, autumn-scented candles and leaves changing colors. Oh, and your social media feeds are soon to be chock-full of everyone and their mother posting selfies with their pumpkin spice lattes!


While the nation prepares for another crisp autumn, women across the country are starting to notice something else peculiar  – specifically about their men. Faces are becoming rougher, upper lips are starting to disappear and the familiar buzz of the electric razor doesn’t sing from the shower anymore. That’s right, it’s just about time for we the uber-macho to start our annual migration toward Destination: Winter Beard.

The recent movement that is No-Shave November has turned what was the cult into now the mainstream, but for some, the winter beard has been a tradition since before the birth of hipsters or pretty much every current Major League Baseball pitcher. In fact, Karl Marx was said to have coined the phrase “no-shave November” more than a century ago in an attempt to encourage facial hair and to piss off the bourgeoisie.

So, at the risk of inadvertently supporting a communist uprising, and as the carriers of the y-chromosome storm the shelves to stock up on beard oils and personal trimmers, I’d like to present the top five reasons that every man should join the beard brigade, and why their ladies should wave the flag in support of their manly-men.

#1: Beards are macho

We’ve heard this so many times that it may seem trite, but there’s no way around it: a dude with a well-grown, full beard just looks more badass. Not to take away from the rigid jaw line of clean-shaven guy, but if I’m going to pick someone for my posse, and I’ve got to choose between Chuck Norris with a beard and Chuck Norris beardless, I know where I’m going.

chuck norris no beard
Who’s more manly?
chuck norris beard
I am, you sissy!

Not to mention, not all men are blessed with a square jaw line and a perfect Adam’s apple. But a good beard can even the playing field between the chiseled and the round. It’s like an airbrush for your face – hiding the subtle imperfections that previously led you to be self conscious.

What’s his face like under there?

Who the hell knows… and who the hell cares? Check out that beard!

He’s a man’s man!

#2: Beards require patience, confidence, attention to detail . . . and believe it or not, hygiene

Growing a good beard means suffering, waiting, and believing that the sacrifice will be worth achieving the goal. The unbearable itch of the first two weeks, the self-consciousness that comes with defining your new look, and the fear of screwing up your neckline on beard-trim day can drive a lesser man to give up on the entire endeavor. But those that persevere through the toils and tribulations will find they arrive in a world of zen, where the little things that used to annoy just don’t seem to be that bad.

Parking ticket?

No big deal, check out my sweet beard.

Boss at work making me stay late on Friday for another ridiculous team meeting?

It’s cool, that’s an hour for me to stroke my beard.

Busted on the BlackJack table with the dealer showing 6?

Okay, maybe not even the sweet shine of a well-oiled beard can dull that pain.

Next time, ask the dealer before you hit, idiot!

Women, if you want your man to be more dedicated, more patient, and maybe even spend a little more time in front of a mirror or showering the stank of his last three workouts off, make him grow a beard. I guarantee you’ve never seen him so careful eating soup from a spoon or had him notice that nasty nose hair creeping out from within his nostril like he will when he’s cultivating a sweet mane of glory.



#3: Your kids will love them

Kids love wrestling with their dads. And every dad knows not to wrestle with his favorite shirt on, because the collar will instantly be stretched into a sort of cloth-made taffy that can no longer be recognized as a t-shirt. Imagine the excitement on your child’s face if dad is sporting a long hairy handle right there on the chin? It’s like they’ve invented a brand new WWE move all on their own: The Beard Grab Paralyzer. Sure, it may feel like someone is literally pulling the skin off of your face, but what’s a few moments of intense, mind-altering pain when it comes to making your children happy?

Lil’ man dreaming about the day he

And while some may still believe that a beard is nothing more than a cesspool of deadly bacteria waiting to attack your whole family in their sleep as a part of a larger plan by lesser organisms to take over humanity, the truth is that a beard isn’t any more gross than any other part of your body. So relax, and let your toddlers indoctrinate themselves into the natural development of their immune system while adoring daddy’s manly “itchy face.”



#4: Beards are a way to express yourself, without needing ink or piercings

I’m a tattoo guy of sorts. I respect the art and have ink myself, and even sported a few piercings back in my younger days. But as an ER doc, I can attest to the fact that society in general hasn’t caught up with the full-sleeves, neck-tatted white-collar job applicant quite yet. But a beard is much more palatable to the PC Police. Why should men who want to bring out their character be forced to only show it off on tank-top day or during the summer at the beach? And who wants to end up with holes in their body sans the piece of metal meant for the hole? Beards are as diverse as the men that sport them, and can be a great way to let out your inner self. Long? Short? Trimmed? Wild and free? It’s your choice, and the decision isn’t final like with a tattoo or body art. Mix it up and keep the world guessing – your face is your canvas!

#5: Beards increase virility

If your man can pull off a beard like a boss, consider yourself blessed, you’ve snagged a more attractive man who is sure to be a better father.

Don’t take my word for it, it’s science!

A study from The University of New South Wales showed that men with heavy stubble scored (no pun intended) higher than men with light stubble or a clean-shaven look on an attractiveness scale as judged by women who participated in the study. In the same study, men with full beards scored as likely better fathers with the ability to provide and protect for their families inferred by women judges.

That’s science, and you can’t argue with science!

There have even been studies that show that beards grow faster on men who have been isolated from their mates for several days, seemingly an effect of the anticipation of returning to his partner. When the lady’s away, the beard will play! See, even your beard knows that it needs to grow to impress the opposite sex!

So, if you or your man wants to step into a whole new realm of badassness, toss the razor in the trash and get ready to embark upon the adventure of a lifetime, where like with Pedro’s presidential platform, “all of your wildest dreams will come true.” Okay, maybe that’s a stretch, but if you want to see what it’s like to be on the bearded side of things, no better time to start than now!

Vote for pedro


Just make sure to thank me if all of your wildest dreams do, in fact, come true.



What say you? Beard or no beard? For those of you on the hairier side of the aisle, do you stick with the winter beard only or go strong all twelve months? Comment below!

Hypocrite Is A 4-Letter Word

Note: This post originally appeared on my first site. I’ve re-posted below. Apologies for such a long read… -TheERDad

Kids are mean.

It’s a sad reality in our world that growing up is really tough, and a lot of it has to do with how mean kids can be. Bullying, teasing, fierce competition at way too young an age, physical and emotional abuse – these things permeate the lives of our children every day. As parents, there is only so much we can do to protect them from the harsh realities of the world. We try to prepare them by giving them a quality education, teaching them manners, building up their self esteem in preparation for when some jerk kid will try to tear it down. We want to prep them for the “real world,” but sometimes we forget that the real world is exactly where they are already living each and every day. And we can’t plan for all contingencies. Kids are mean, and they are going to be mean to our kids one day.

In our society it is too often surprising and inspirational when someone treats another human being like just that – a human being.


I was watching the news a couple of nights ago, and saw a story about a young boy with autism in Florida who ate every lunch alone, presumably because the other children in the school wouldn’t sit with him. A Florida State Seminole football player was visiting the school and made the choice – impromptu, it seems – to sit with him. This made the news as a “feel good story” and the boy’s mother spoke out in the general  and social media about what a wonderful thing this was. And I agree, it was fantastic. Kudos to a young man with, quite frankly, a lot going on in his life who took the time to just sit with a kid who had no friends and deserved one.

But here’s the problem I have with this story: It’s the fact that we’ve had to make it a story at all! In our society it is TOO OFTEN SURPRISING and INSPIRATIONAL when someone treats another human being like just that – a human being.

That kid deserves a friend. He deserves to have a child sit with him at lunch, someone to make jokes with,  someone to talk with about the latest Marvel Superheroes movie, someone to complain to about the fact that his friggin’ mom packed him yet another friggin’ peach yogurt and she knows how much he friggin’ hates peach yogurt! Hell, he deserves to have someone sit silently next to him just because, in a show of solidarity. He deserves to have these things because he’s every bit as much a person as you or I. In fact, he probably deserves these things more than you or I.

Does anybody know if you can house train a pony???

I was putting my daughter to bed one night, and as we went through the bedtime routine, she proceeded to tell me all about her school day. The stories went on and on, one leading seamlessly into another.  Just another attempt to delay the “lights out” call, as is her custom. This was a new school for her – my wife and I recently moved our family to a new (read: better) school district. She was telling me all about her friends, her teacher, about the games they played and the girl who sits next to her and how “she is so nice and her name is ______ and she has to be in a wheelchair because she got hurt when she was younger. . .”

Now, I’m not looking to violate anyone’s privacy, or make an example of any one in particular – certainly not an innocent little girl who just happens to go to school with my daughter. But this got my attention, and I wanted to see what my parenting for the last eight years had taught my daughter about how to interact with someone who has something different about them that is so clear and present on the surface, and so inconsequential deep down. Does she talk to the girl? Does she play with the girl? Has she made a point to sit with the girl, include her in group activities and see to it that that little girl doesn’t spend the third grade alone? Was she the champion for humanity that I’ve built her up to be in my head: striking blows to those who judge and lifting up any who are persecuted like a modern day super heroine? Does she ride in on her white horse to save the day and rid the world of evil?

After all, every super heroine needs a white horse. It’s mandatory super heroine issue.

boy child clouds kid

What I really wanted to know was: did this little girl have to endure cruelty because of her physical appearance, and what was being done about it?


The answer relieved me, this time. As I asked (more subtly than above) about how the other kids interact with this girl, and how my daughter specifically does, it seemed to be no big deal. Turns out the school district we chose really is fantastic. There are aids, helpers, and necessary accommodations given to make things as seamless and productive and enjoyable as possible for all the kids who attend. It also appears that – so far as my (very observant) daughter has noticed – there have been no instances of discrimination, teasing, poor behavior or the like by the kids in the class. Things seem to be going well. It appears I need to make more friends with parents in the district, because they know how to raise their kids not to be little asses.

I like parents like that.

But we began to talk, and I explained to my daughter that there are going to be times in her life that she will see someone who is “different” from her or her friends being treated poorly just for this reason. A kid who is “weird” or “ugly” or “fat” or whatever is going to be treated badly in her presence, and we talked about what she thought of this and what she would do in such an instance. I told her about the boy with autism in Florida, and left out the part about the football player making a choice to sit with him, and asked for her impressions.

“I don’t think that’s right,” she told me. “I would tell my friends to stop it and I would be that kid’s friend. In fact, daddy, I’ve kind of decided that I don’t think I’m going to go the same way as the crowd most of the time . . . I think I’ll go my own way.”

. . .

I just finished buying my daughter a white pony online. Do you know how much a pony costs???? Does anybody know if you can house train a pony???? No matter: a super heroine needs a white horse, so a white horse she shall have.

. . .

In truth, my daughter has an incredible heart and is just a good person to begin with. I credit mostly her mother but partly myself for teaching her to value every person equally without judgement, and to stand up for what she believes in without fear or apology, and to think about what her parents and her faith and her God have taught her to do in this life, and to show respect.

But then again, she’s eight. Eight is pretty easy when compared to other ages. Long as you like dolls, toys, playing kitchen or ponies, you’re pretty much in good with most eight year old girls. But I know that being the champion for the people is going to get harder quickly. I pray she’s got the foresight and intestinal fortitude to do exactly what she says she’ll do and to tell “the crowd” to screw off, but I know how hard it can be when faced with that choice. It’s much easier to stay under the radar and just go with the flow. What will happen when taking a stand literally means losing her “friends” or her social status? I won’t be there to help her make that choice in real time, so I want to prep her as much as possible ahead of time.

Lessons given fade often, but examples set are lasting.

So what can we do as her parents? We can talk, lecture, teach and remind her until we’re blue in the face. We can punish her when she’s mean, reward her when she’s nice and treat  her like Pavlov’s dog until we get the reaction we desire when she is delivered the same exact stimulus over and over. We can literally train her to act in a certain way and instill in her an understanding for the way others are to be treated. And we can, by doing this, raise a pretty decent kid.

But then she sees me screaming at the old man behind the wheel of the car ahead of me to get the hell out of my way.

She sees my wife purposefully avoid the register at Wal-Mart where the mentally handicapped person is trying to make a living bagging groceries – albeit very slowly.

She has to get up and move with me when I move away from the person sitting next to me in church who smells badly.

She hears the tv show I’m watching make fun of a fat person, a gay person, a religious person.

. . .

She hears (and recognizes) the racist or sexist or ethnically charged undertones in our “grown up” conversations in the kitchen, when the real ugliness creeps out.


And it does creep out at times, for all of us.


If you don’t think you have an ugly side, buy a new mirror.

. . .

Suddenly, all that teaching we’ve done is a waste. The lectures, the lessons, the pleas, the punishments and the rewards are all washed away with the same hypocrisy that ushers in a new reality for our children to see. They are left with uncertainty about what to do, void of that confidence to be the righteous person their mommy and daddy told them to be. Because if mommy and daddy aren’t even that righteous person then it must be because being that righteous person is scary or sucks!

Now, I’m not looking for or expecting perfection in parenting. Lord knows I fall short if that’s the standard. And I’m also not arguing that you have to turn off the show you’re watching in the background right now. You know, the one that toes the line between being hilarious and making you really uncomfortable when your mom is in town visiting and watches with you. Go ahead and listen to that song on the radio that you probably wouldn’t listen to if your pastor was in the car. Chuckle at the joke you heard at work today that you probably won’t repeat tonight at your dinner party. I understand that context is key. The way we act, interact and react is often dependent upon our company, our audience, our situation. You wouldn’t watch that movie with your kids but your wife and you really enjoy it. I get that. Politely steering clear of the guy at work who is so annoying  you want to stab yourself in the eye when he starts talking to you isn’t the same as publicly and violently berating the barista at Starbucks who messed up your latte because his English isn’t so great. I understand that maturity and situational analysis, farse, humor, sarcasm and mastering the complexities of adult interaction all matter. Real life necessitate that we consider the environment before making a judgment or jumping to a conclusion that person A is a racist or person B is a judgemental ass. I understand that. And I understand that there is a difference sometimes between what you might say and who you might be.

But do our kids?

Because here’s the the thing: our children see us better than they hear us. Lessons given fade often, but examples set are lasting. Our children have to see us being the person we teach them to be so that they will have the courage to do the same when doing so is hard. And it often will be.

Ask yourself this question: if you could see yourself through the eyes of your child, would you like what you see? If the answer is no, then you have a lot of changes to make. I would imagine most of us do. What better motivation for change than the good of our children?

In the Emergency Department, I get to see a lot of bad choices. A good amount of what affects my patients is a result – direct or indirect – of the choices they’ve made for themselves. I often leverage my patients’ roles as parents to try to affect positive change for their health. Pleading with a grandmother to allow me to admit her to the hospital for her chest pain because I’m worried about her is often ineffective. Suggesting she stay the night so that her grandchildren won’t have to worry about her usually does the trick. Explaining to a mother that the internet article she read about vaccines and autism has been debunked over and over (and over) rarely carries weight (because what do I know, I’m just a doctor).  But explaining to her that childhood meningitis is very real and very deadly often convinces a mother to do the right thing. Lecturing a forty year old man on the dangers to the heart that smoking creates is a useless endeavor. Looking daddy in the eyes and asking him if he’d like his eight year old son to smoke some day too usually receives a thoughtful pause. Change is hard. Failing your children should be harder.

(Side note: I’ll post on vaccines some other time. This post is long enough already…)


There’s no question that this is a constant struggle for all parents. If any of us believe we’ve got it figured out, that’s usually when one of our children humbles us – quickly and skillfully. Every day I struggle to be the person I teach them and expect them to be. I fail often. We all do. But it’s a strive for forward progress that makes us successful in the long run. It’s being mindful always of the little person whom you are literally molding into a big person. You will leave no bigger footprint on this world than your children, and you will affect no one more during your days on this earth than you affect them. We as parents have to make choices in our life that emulate the lessons we teach, so that our children will see the integrity behind our words and develop the confidence to adopt that same integrity.

Our children will become us, whether we like it or not. Certainly not in every way, but often in the ways that matter. We have to remember this as parents. We have to believe it. That belief can motivate us to change ourselves in order to influence our children. It will remind us to calm our tempers when faced with mounting frustrations. It will help us to be kind to those who may not seem to deserve our kindness. It will teach us daily to value what is most important in our lives, and teach our children that the value of their worth is not measured by physical appearance or ability, by skin color or ethnicity, in number of friends, party invites, dates, trophies, or social media likes. It’s measured by something much deeper, much more concrete.  It’s measured by the level of effort we put toward being a better person each day, and by how we treat each other.

I know you want your children to live amazing, fulfilling lives rich with experiences, accomplishments and excitement. I do too. All parents do. Whether our child is the most popular kid in school… or the least. We as parents living in a community together have to make sure that every child has the opportunity to live out that goal, and that the people we are raising and placing into this world do the same. And it starts with us recognizing the value of one another, and choosing to celebrate and cherish that value publicly, for our children to see.

So let’s all try to do a little better as parents to be the change we want to see in our children – let alone the world. Let’s work to teach them, by example, how to practice acceptance of people’s differences and be a champion for what’s right. Let’s teach them to be a voice of the voiceless and a friend when a friend is needed. Let’s encourage them by living out the lessons we teach. We can do this! We should do this!

We can elevate our children toward greatness all the while cultivating their character. The two are not mutually exclusive. I’m just like most dads – I’d love to see my son one day out on the football field catching touchdown passes and being carried off the field by his teammates.

But i’d be just as proud to see him sit quietly at a lunch table with a little boy who just needed a friend.


What do you think? How has parenting changed you when it comes to acceptance and the way you interact with others in your world? What lessons can you live out better for your kids? Comment below!


Thanks For Reading

The ER Dad

The Art of Eliminating “No”

I have three kids. I say ‘no’ a lot. A whole lot. Probably too much. So, I decided I wanted to try to say it less. But, when I found myself challenged with the task of avoiding saying ‘no’ for one whole week, I wondered how in the hell I’m going to pull such a challenge off without ending up duct-taped to the office chair wearing a princess dress and watching three little monkeys throw M&Ms at each other across the living room.

It was going to be hard to be a (good) dad and not say ‘no’.

The first challenger: my wife. Day 1 of my no ‘no’ challenge started in a text, like this:

Me: “I decided that I’m going to go 7 days without saying ‘no’.”

The ER Mom: “Can we build a pool this summer?”

Well played, my dear. Well played indeed. My retort:

Me: “I would love to do that! Let’s look at our funds and see how possible that is.”

Boom! Right off the bat I found a way to avoid no but not say yes, either. And, it was true. I would love to have a pool! What I would not love is the debt that often comes with putting in a pool. I got to say what I really wanted without just saying ‘no’. I’m feeling pretty good about myself right about now.

She wasn’t to be outdone.

The ER Mom: “Can we swim with dolphins in Mexico?”

I could see this was going to be a long week. But, so far, so good. At least the tough week might end with a fun swim with a dolphin or two…

Having three kids, with seven years separation between first and last, I’ve noticed how impotent the word no really is. It seems that children become quickly desensitized to this word and that it just doesn’t carry as much weight as we, the parents, may wish. This is especially true in the toddler stages. I have a two year old daughter who has a very literal definition of what no means when she utters the phrase.

“Do you want to take a bath?”


“Let’s go to bed.”


But, when she hears it, it seems to mean something else. To her, the word “no” may mean “go ahead and climb onto the top of the couch then super-man off onto the floor, just make sure you do it with a sly smile on your face” or “I think it’s awesome when you throw spaghetti across the room onto the white walls, keep going!” But, while the toddler may misinterpret what I mean when I say to her literally the very first word she ever learned to say, my older daughter – who will soon be eleven – has an entirely different viewpoint of what response “no” should elicit. Namely, a debate.

“Why not?”

It’s the phrase most commonly employed by my oldest. She asks this – I am convinced – because she knows that often I don’t even have a good reason for saying “no” other than her request simply doesn’t suit me, my mood, the current situation, or what have you. Her approach (and it’s a good one) is to hopefully catch me unwilling to say “because I said so” at least one out of twenty times and have me reconsider in a moment of guilt mixed with exasperation mixed with pity and thus allow her to continue down her intended path. In truth, it’s probably more like one out of every twenty-five times I give in, but still that’s a pretty good strategy for someone who is just learning to master multiplication and division.



“How many times in my life have I missed out on something I would have loved to do, or an opportunity to affect someone’s life in a positive way because my track record or body language screamed ‘no’?”



But beyond the constant battles that we face when saying no to our kids, what does it say about us if we are in a constant mode of refusal in our daily lives? We have all seen the self-help gurus who tell us that one of the crucial steps to finding inner peace is learning to say “no”. I think that’s useful when we are in a situation where we are constantly and literally  being taken advantage of. Agreeing to complete someone else’s project, lying to your boss at the request of a colleague, or loaning money to a family member or friend whom you know will never pay you back all probably deserve a firm response toward the negative. But how many times in our daily lives are we really put in a position where saying “yes” will cause us anything worse than a minor inconvenience? And what’s more, how many times are we not even given a chance to say “yes” because the person(s) in our relationships have learned to expect a “no” and thus avoid the question altogether?

I remember a job I had years ago working in an emergency department. The staff loved to go out for breakfast and beers after the last night shift of the stretch. I found myself one day really hoping to be invited (it was a long, painful stretch of nights), but nobody approached me with an invitation. I asked a nurse friend of mine once why. Her response? “We didn’t figure you wanted to go because when we used to ask you’d always say ‘no.’” How many times in my life have I missed out on something I would have loved to do, or an opportunity to affect someone’s life in a positive way because my track record or body language screamed “no”?

I decided to spend a week letting “no” be a word lost from my vocabulary. I was going to make a concentrated effort in every part of my life to avoid saying “no” to anyone for any reason. It seemed impossible, until I tried.

Me (in the back) prepping to ride “The Comet” at the Olympic bobsled track in Park City. Saying “yes” can lead to some (fast) fun!



“Knowing that I was open to any opportunity, request or situation made me actually interested in what was to come that day.”





The first thing I found was that I was excited to give it a shot. Knowing that I was open to any opportunity, request or situation made me actually interested in what was to come that day. I was excited to see what there was for me to experience when I was willing to at least consider experiencing everything. I actually woke up happier to start my day than I had in awhile.

What I didn’t experience was an overwhelming list of unreasonable asks on the part of those I came into contact with. Now, this was only a week long experiment, and it’s not as though I walked around with a sign reading, “yes man” on my chest, but I didn’t find myself actually all that burdened with the overwhelming amount of requests for my time, talents or money that I’d previously managed to convince myself existed before I’d taken on this task. Is it possible that I had overestimated how many times I’m asked for a favor or a task? Do we like to think of ourselves as taken advantage of more often than we really are? I don’t know if I can generalize a week into my life, but I know that saying “yes” didn’t really affect my life in such a way that I was sorry to have taken on this challenge.

In fact, I kind of liked it.

There are two things I got out of this challenge that made me so glad I had done it. One was learning how to say no without saying it, and we’ll get to that in bit. The other was that I was having fun with my kids again. I played more games, watched more shows, pretended to be more characters and gave more piggy-back rides than I had in a while, and I really enjoyed it. I won’t lie and say that each time I was asked to play I didn’t first start to vocalize the words, “not right now” but once I’d gotten past the initial “yes” response, I found myself really having fun. I considered myself a fun dad before this, but after a week of just saying yes, I looked before like the dad from Harry Chapin’s “Cat’s in the Cradle”:

“When will you give me a piggy back ride, dad?”

“I don’t know when. But we’ll get together then.

You know we’ll have a good time then!”

Now, don’t get me wrong, there are plenty of times that we can’t allow what’s happening to continue, or just can’t respond in the affirmative for whatever reason. See the above analogy of the family member bumming cash or my son doing free-dives off the back of the couch. But what I learned in my week of no “no” was that we can say “no” without every really saying it.

And people respond so very differently.

Instead of “no” when my daughter wanted to stay up past ten o’clock, my response was something like this: “it’s already past your normal bed time and you have to be up tomorrow at seven and have a pretty big day. Do you think it’s a good idea to stay up so late?” That seems like a heck of a bluff, and it is, but kids are smarter than we realize, and when given the opportunity and a little coaxing, can make the right decision for themselves. Besides, I had already decided that if she called my bluff and said that she thought it was an excellent idea, I would responded, “alright, I’ll make a deal with you and you can stay up 20 minutes longer than I think you should, but then it’s definitely time for bed.” I didn’t say no, but haven’t given in, and in reality 20 minutes isn’t going to make or break her day.

Even my two year old can be redirected without a “no”. Example: “I wish you wouldn’t throw your toys over the upstairs balcony.” sounds so much more calm and reasonable than, “NO!”

The response you get when learning how to say “no” in a different way can be even more dramatic when you practice with other adults. In my profession, I am often asked to do for or supply my patients with various things that they really shouldn’t have done or given to them. It can be easy to simply fall into a trap of perpetual “no’s”, which usually winds up in either a heated discussion or you answering for a complaint the next time you see your medical director. But there are ways to avoid having to do things without being a Nancy Reagan and just saying “no”.

“You know, Mrs, Smith, I realize that you came here expecting an MRI of your brain today, but I don’t think that’s what you need, and let me explain to you why.”

“Mr. Jones, I think that if I refilled your narcotic medication for the third time this month we both may be worsening what I’m afraid is a serious addiction problem for you. That’s not something I’m willing to do to you.”

“Bill, I’d love to help you on that project, but the truth is that I’m really swamped right now and I just know that I can’t give you the kind of effort and results you need. I’m sorry.”

The “no” in all three of those examples is very obvious, but it isn’t stated, and that’s a big deal. There is something about the word itself that casts a shadow over any reason or intent one may have. We can keep our sanity, protect our privacy, and deflect our manipulators without going down the road of “no”.

And we may even find that, occasionally, we want to say “yes”.


What do you think? Can you find places in your life where “no” holds you back? Comment below!


Thanks for reading, 

The ER Dad

Budgets Are For Losers (who have money)

“Can we afford it?”

I hate that question.

Being the one in my family who spends the most amount of time monitoring our finances (my wife isn’t nearly the spreadsheet nerd that I am), I’m asked that question often, and there is never an easy answer. When someone in the family asks me that question, it is innocently framed as a “yes/no” question, but it’s a much more complicated question in my mind, with an answer that moves around like a “choose-your-way” storybook.


Can we afford it?

Well, that depends. What’s your definition of “afford”?


Do we have the money in the bank to pay for it?




If we don’t have it in the bank, do we have enough open credit on our card to charge it?




Do you think a bank would loan us the money if we’ll promise to pay it back with interest?

Almost certainly.


So, can we afford it????

My dad used to tell me, “you can have anything you want, you just can’t have everything you want,” and that’s exactly right. Life’s gratifications are simply an ever-changing laundry list of what’s most important to each of us as an individual, and the amount of capital we possess – be it financial, emotional, time, whatever – is what determines how many of the items on the list we are able to afford. That capital has to be portioned off in bits and pieces lest it run out completely and before we’ve done/gotten what we want to do/get.

None of us can literally have everything we want. But with a little planning, when it comes to goods for purchase, most of us could have any one thing we want.

So yes, we can afford it. But at what cost?


We’ve all heard the the saying, “those who fail to plan, plan to fail.” The biggest mistakes I’ve seen people make when it comes to personal finance are all a direct result of a failure to plan. You wouldn’t recommend someone start out on a hike through the mountains without first plotting a course, or that the pilot you trust to take you to your vacation destination do so without first calculating how much fuel it’s going to take to get there. So why do so many of us go about our financial lives with our collective heads in the sand, spending money and consuming goods without any real idea of a plan to make the money last, and to allow the money we earn to function at its greatest potential?


This ER Kid saved up money (probably selling teeth) to budget for Disney World souvenirs!

Because it’s no fun. And because, let’s face it, budgeting can suck.




But guess what? Budgeting is an unavoidable consequence of adulting. And adulting sometimes sucks.




Seriously, whether we like to admit it or not, we all need to budget at some point in our lives. Even if your method of budgeting is similar to my college days of trying to figure out how many gallons of gas I could get with the cash in my pocket and still have some left over to buy beer, that’s still budgeting. As we grow and acquire more responsibilities (read: liabilities), our budgeting hopefully becomes more sophisticated. If it doesn’t, our financial picture most certainly becomes more ominous.

As I mentioned above, I’m sort of a spreadsheet nerd, and I budget accordingly. Microsoft Excel is pretty much always open on my laptop, and I’m usually working on some sort of financial analysis – whether it be tracking my investments, comparing the financial ramifications of new investment opportunities, or even analyzing the multiple potential outcomes of one of many financial scenarios. I have a detailed budget I’ve created for our family on Excel, and the color coding, IF/THEN functions and various columns makes my wife’s head spin when she glances over my shoulder to see what’s been occupying my time in the evenings. I admit, it’s overboard, but it’s something I like to do, and I find peace in knowing that I’ve got a pretty tight handle on all things budgeting in our family.

But budgeting doesn’t have to be that tedious. It doesn’t necessarily mean planning for every conceivable eventuality, or slaving away over a calculator every Sunday night sweating the small stuff. And if you aren’t taking at least a little bit of time every now and then to take an honest look at money in and money out, and setting some goals for yourself in terms of saving some money to the side and finding a way to get ahead financially, you’re doing it wrong. And you’ll likely regret it sooner than later.

J. Money, of the site, has a great site dedicated to discussing personal finance and the importance of budgeting. Obviously he (and I) probably go at it with a bit more intensity than the average person, but if you spend some time exploring the reasons why, and the stories of those who have and have not taken it upon themselves to start budgeting, I think you’ll see that it’s a really good idea.

So, how should one go about budgeting? What’s the best way to sort that laundry list of wants and needs and try to afford as many of them as possible? Well, that’s a really difficult question with a very personal answer. There is no one-size-fits all solution. Many people are, by nature, less apt to consume goods and therefore spend their money, and they have no trouble at all holding on to their finances and covering expenses with ease. Others find that money literally flies out of their hands and they are forced to wait desperately for their next paycheck just to cover the expenses from their last. I would guess that most of us are somewhere in the middle – looking for a way to improve on their spending habits and maximize the potential for their money without creating too much extra hassle in their lives.

Really, I think the answer to how to start a budget is simply that: START! Make the decision to track your expenses – down to the penny – for a period of time (I recommend at least three months). If you don’t know what you really spend, you can’t know what to realistically budget for. You’ll probably be astonished at how you actually spend your money. Maybe it will motivate you to change your spending habits, maybe it won’t (we all need to do what brings us the most joy), but at least after paying close attention, you will have real data to rely upon when making a budget. Then, once you know where your money is going, see how it compares to money that’s coming in, and break down your spending and saving habits into categories with a goal in mind.

Always try to set aside at least a little bit for long term savings, and debt payments. And never budget more than you’re going to make. Relieving yourself of the burden of debt is the best thing you can do for yourself financially!

Me when I finally make my last debt payment!

If you have a significant other, make sure to involve he or she in the process. They may be weary when you first mention the word “budget” (dun dun dun!), but if you go into the process calmly, slowly and keeping the wants and needs of each other in mind, I think you’ll find that there is a lot more collaboration than confrontation. And if you just keep ignoring the subject, you’re headed for a doomsday scenario anyway. Everyone knows that one of the most common reasons for divorce is financial strain.


If you’re still unsure how to get started, take a look at some sample budgets I’ve made as suggestions to share, and see if one works for you. Or, if you’re sure you want to get on the budget train and go all in, take a look at various software platforms available. In another post, I’ll share with you my review of the software we use in The ER Dad household, but if you’re interested in taking a look now, here’s the link: You Need A Budget. (Note, I do get some free time added to my personal subscription if you sign up via this link, so thanks in advance if you choose to try it out!)

Budgeting doesn’t have to be sexy. It doesn’t even have to be fun. It doesn’t have to be a stress in your life, either. But if you want to get ahead in your finances, and open doors to more items on your laundry list of wants and needs, it does have to be done. And, the sooner you get started, the sooner you start to realize that “can we afford this” becomes a much easier question to answer.

-The ER Dad


What are your thoughts? Do you budget? How do you do it? Comment below!


How to punch a dead man in the chest . . . and end up a hero!

If you don’t know CPR, you should learn. It’s cheap, easy, and may save someone’s life someday.

Having said that, did you know that CPR success stories – in general – are rare? In fact, the likelihood of someone having sudden cardiac arrest outside of a hospital, receiving CPR and walking out of the hospital at all (let alone with good neurologic function, i.e., the brain isn’t damaged) is actually pretty crappy.

According to a 2015 study by the AHA, the rate of ROSC (return of spontaneous circulation) and subsequent survival from the hospital in a patient who had sudden cardiac arrest and received CPR by emergency medical services prior to the hospital was only 10.6%. And, only 8.3% had good neurologic outcome.

Pretty crappy.

But wait! There’s more!

Of the patients who received bystander CPR, meaning a good samaritan like yourself happened to see someone go down and think, “hey, I think that guy just died, I’d better do CPR!” and actually did it, 31.4% survived!

Now, I don’t know about you but I’ll take a three-fold increase in my likelihood of surviving any day of the week. In fact, if anybody plans to spend much time around me, maybe I need to pay for all of you to learn CPR!



In the 1970s, two doctors at Harvard – James E. Pennington and Bernard Lown – started studying the effect of “thumping” someone in the chest who had suffered sudden cardiac arrest. They were able to show that a forceful blow directly to the sternum could potentially get the heart out of an arrhythmia such as ventricular tachycardia (VT) and ventricular fibrillation (VF). Bear in mind, CPR wasn’t even officially endorsed by the AHA until 1963, so this was pretty groundbreaking stuff back then!

So, how is it done? It’s easy, as described below:

  • If you witness an individual collapse and show no signs of life, first get help. Go yourself or ask someone to call 911 and to bring an automated external defibrillator (AED) if one is near.
  • Assess the individual for responsiveness. (This isn’t where you get to punch them… that part’s coming!) Tap them on the chest firmly and ask, “Are you okay?”
  • If there is no response, check to see if a patient is breathing and has a pulse. This is the look/listen/feel stage. Don’t take more than 10 seconds. if you find a pulse, great. If not, move on.
  • If there is no pulse, then this is your moment! Clench your fist, hold it ulnar (pinky) side down (like you might bang it on a table whilst showing your boss who’s really boss in a meeting) about 8-10 inches above the person’s sternum, and deliver a sharp blow to the sternum. Immediately retract your fist almost like a whipping action to create a rebound of the chest as you remove the force.
  • Start chest compressions at a rate of about 100-120 per minute.

There you have it: the process of punching someone a dead person in the chest and saving their life.

The discovery of this procedure – affectionately known as the “Precordial Thump” – was actually by mistake. Paramedics transporting a cardiac arrest patient hit a speed bump, and the jolt delivered to the patient’s chest in the back of the vehicle apparently saved the patient’s life! Funny how science is so non-technical when you get right down to it.

“So, Sam, I hear you had a major heart attack? Glad you’re doing well! What did the doctor say?”

“Not sure, Bill. I never saw one. Damned ambulance driver hit a telephone pole and I just woke up. Never did make it to the hospital.”

I’ve actually seen this done multiple times in the ED. I can remember once that the patient immediately awoke after a thump on the chest and a short (seconds) period of chest compressions. I know doctors who use this maneuver in their repertoire regularly when dealing with sudden cardiac arrest. I can’t say that it’s often this comes up for me, but for a handful of times. . .


Now, while this may seem like a cool party trick for your next office Christmas party, the truth is that it’s probably not all that effective, and may even be harmful. As it turns out, the survival rates still weren’t all that great, and there were reports of other injuries such as sternal fractures, cardiac contusions, etc.. Still, I know some physicians and EMS providers who would argue that this is still something to be tried when things are as bad as bad can be. After all, a common adage of the ED is that  you can’t kill a dead person. Still, the evidence is pretty clear that this technique isn’t really all that helpful, and probably only delays time to good bystander CPR, which is most definitely helpful.

In fact, in 2010, the American Heart Association released new guidelines stating that a precordial thump should not be used in unwitnessed cardiac arrest outside of the hospital, and should be considered only if there is a witnessed arrest into a (monitored) VT. In other words, if I’m your ER doc and we are talking while you’re on the telemetry monitor, and you pass out and I see your rhythm change to VT, I’ll probably punch you in the chest. Sorry and you’re welcome. But, if I’m out walking my dog and see you lying on the ground without a pulse, I’ll stick with good ole’ CPR, and would suggest you all do the same!