A child, who can’t swim, jumps into the deep end of the swimming pool. A man chokes on his food while eating in a restaurant. A friend goes into shock. A woman faints. All of these scenarios share common ground. They all include a victim who is lacking oxygen. People need to know what to do in these emergency situations.

Approximately 330,000 people die annually because they do not reach the emergency room in time. This number would decrease rapidly if the emergency room paramedics weren’t the only ones who know what to do. Recently, I was at a friend’s house. There was a platter of candy and gum near us, and her little sister was inhaling more of it than could fit in her mouth. She started choking. We all started screaming, but not really doing anything. We were five girls who had no clue what to do. Yet, just knowing a few simple steps can save a person from possible brain damage.

First off, if someone can talk or breathe, they aren’t choking. Have them continue to cough until their airway is clear. There are certain signs that can tell you if someone is choking. For example, if a baby is choking, his or her skin will change to a reddish color, and then turn blue. An adult’s neck might start to bulge, and his or her face will turn red and puffy. If you are qualified, and you see that someone is choking, start to employ CPR (cardiopulmonary resuscitation). Place a fist below the victim’s ribcage and do thirty rapid compressions in less than eighteen seconds, but on a child or infant, remember to do the compressions in a more gentle manner.

There is a mnemonic device that can help you remember the steps to follow in an emergency situation: DR911ABCD.

D-DANGERS. Look around you and make sure that there are no dangerous objects near the victim, such as fire, glass, gas, or open wires. Assess the victim.

R-RESPONSIVENESS. Check to see if the victim is responsive. You can do this by inquiring as to whether he or she is okay and if you can help.

911- Call 911 and report your emergency.

A-AIRWAYS. Make sure that none of the victim’s airways are blocked.

B-BREATHING. Make sure the victim is breathing

C-CIRCULATION. If the victim is not breathing, start doing CPR. After four to six minutes without oxygen the heart will stop beating. Brain damage is certain after ten minutes, so time is of the essence.

D-DEFIBRILLATION. If the victim is not breathing, and the CPR has had no effect, use a defibrillator. An AED (automated external defibrillator) interprets heart rhythms. Two heart rhythms can mean cardiac arrest. Cardiac arrest is when the heart stops beating. Ventricular Fibrillation (VF), when the heart is shaking like jelly, and Ventricular Tachycardia (V-Tac), when the heart pumps 200-300+ a minute. Chances of survival decrease 7-10% for every minute waiting for defibrillation.

The DR911ABCD measures can be used for most emergencies, in addition to hypothermia (when the body temperature is 95 degrees or lower), and shock (when there is a lack of oxygen in body tissue).

This past summer, my two-year-old cousin was at the pool. As the whole area emptied, he ran back, alone. He slipped and fell in the deep end. He didn’t know how to swim, so he sank to the bottom. The lifeguard on duty didn’t see him. She finished up and started to walk out. Glancing down, she saw a blue form at the bottom of the pool. Instinctively, she dove in and pulled him out. Screaming for help, she started to do CPR. My cousin was brought to the hospital, and now, Baruch Hashem, he is fine. His parents have started a program called Project Moshe- Learn to Save a Life.

Do you want to be ignorant or knowledgeable? The information that you can acquire may be the very thing that saves someone. While you may convince yourself that this isn’t something you need, trust me, you do. It could be your mother, sister, cousin, or best friend. Don’t take the risk! Learn CPR, and learn how to save a life.

Rav Yosef Shalom Elyashiv condition has deteriorated again, and he is currently in critical condition.

Elyashiv is on a respirator. He has been resuscitated four times, and is currently undergoing CPR.

The area in the hospital in which he is located has been cleared and the doors locked.

Prime Minister Binyamin Netanyahu called MK Moshe Gafni and said the country is praying for the health of “the greatest rabbinical sage of his generation.”

In marriage, money tends to mean different things to different people. Unfortunately, for some, money repre­sents more than economic security. It becomes a symbol for CPR — Control, Power and (self) Respect. In so many of the cases I work with, money is related to unresolved childhood issues — childhood needs and yearnings that were not met. In many cases, children who had a problem­atic childhood will enter into an adult relationship with a powerful need for control. This is often played out through money. Issues involving money will often mask deeper core issues for the fulfillment of childhood yearnings.

As adults, some people feel they must handle the fi­nances in order to preserve their sense of importance and dominance in the family. In my own research with couples, I have found that if a man or woman’s position in the fami­ly can be maintained only by power, he or she wields control of the money. As one man said in my office, “As long as I hold the purse strings, I have the last word!” What is sad is that after the divorce, his family wanted nothing to do with him or his money. The fact that he felt he was controlling the money for their own good was of little significance.

How does this process begin? Many psychologists feel that the early stages of childhood, ages birth to six, are the most crucial years in developing positive self-es­teem. During these stages, the child needs to feel secure and connected to his caregivers. The important parental task is to notice and acknowledge the child’s needs. The child wants to be visible and be recognized as an individual. This visibility is very much needed so that he/she can feel control of his/her life.

When my children were younger, they would often play dress up. They would put on our clothes and make believe they were mommy and daddy. Once, they got hold of some of my tools and played Bob and Prim, two mainte­nance workers in the building we lived in. Back then, when we had a TV, they would dress up as Batman or Power Rangers, and my wife and I would say “Wow! You are Power Rangers!” It was fun and they felt good to be in control as they got lost in their make believe world. They did this because they wanted to be somebody. They wanted to feel special and have recognition.

Many parents only take the opportunity occasionally, for example on Purim, to acknowledge how cute and spe­cial their kids are. It is not that they are neglectful par­ents. It is just that they are too tired, too stressed, too angry, too worried about what school to send their kids to, etc. Parents today are running on overdrive to make sure that they are always available! Instead of acknowledging the children for who they are, they criticize and judge them for who they are not! In time the child will start a process called negative self-esteem. The child does not feel good about himself or in control of his life. Without positive self-esteem, the child’s emotional growth is affected.

Nothing they do will ever be enough for them.

As they move into adulthood, they will do whatever is necessary in a relationship to obtain CPR — Control, Power and self-Respect, in hopes that it will make them feel better.

“Money” and “Self-esteem” are two of 21 topics that I discuss with the brides and grooms in my Pre-Marital En­hancement program, using the T.E.A.M. approach (To­rah Education and Awareness for a better Marriage).

If there are any topics you would like me to discuss in my articles, or if you have any questions, please feel free to contact me at CPCMoishe@aol.com or at 718-435­-7388. You can also log on to CPCTEAM.org to download past articles and for more information about the T.E.A.M. approach.

Moishe Herskowitz MS., LCSW, developed the T.E.A.M. (Torah Education & Awareness For A Better Marriage) approach based on 20 successful years of coun­seling couples – helping them to communicate effectively and fully appreciate each other. As a licensed and highly certi­fied social worker and renowned family therapist, he devel­oped this breakthrough seminar to guide new couples through easy-to-accomplish steps towards a happy, healthy marriage. Moishe Herskowitz holds a certificate from the Brooklyn Institute for Psychotherapy and Psychoanalysis in couples and marriage therapy. He is an active member of the New York Counseling Association for marriage and family counseling. Mr. Herskowitz can be reached at 718­-435-7388.

Last week I wrote about how some well-meaning professionals can manipulate the situation in order to get you to do what they feel is in your best interest. I retold Brocha’s experience when she was agonizing over whether or not to place her chronically ill husband in care. Brocha was haunted by what she thought she had been (deliberately?) told. Not able to check it out, she allowed the (mis)information to determine her decision. I also told Joe’s story, according to him, of how he was pushed out of a rehab facility before he felt he was ready to leave. This week I want to relate more stories told to me by the chronically ill and their families. Stories in which these people feel that they too, were manipulated by the system to do what was not – in their opinion – in the best interest of their loved one.

Ada had been chronically ill for years. As she aged and her disease worsened her hospital stays were longer and she was admitted to the hospital more frequently. Lately, she often referred to the hospital as her second home. The nursing staff, doctors and orderlies on every floor knew Ada. She was no stranger to the Intensive Care Unit, either. Ada had always told her family and her doctors that she did want every heroic measure taken to keep her alive, no matter what.

The last time she entered the hospital she had difficulty breathing. The doctor asked Ada’s husband how he felt about a DNR order. The doctor’s prognosis was that Ada’s breathing would just get worse and worse, and the chronic illness would not allow for recovery. The disease was just taking over the body.

Ada’s husband again relayed Ada’s wishes to the doctors, that she be kept alive, no matter what. He told the doctor that he wanted her wishes honored. At that point, the doctor reminded him that as long as Ada was lucid a DNR order was her decision. The doctor thought that perhaps with no chance of recovery, Ada might have changed her mind about choosing to prolong her life, no matter what. The doctor was determined to discuss the options with Ada herself.

Ada’s husband requested to be present at the discussion. He was concerned how the doctor, with his own point of view, might word the discussion. After all, the hospital had a shortage of beds, and

perhaps the doctor didn’t like dealing with patients who could only get worse and never be cured. And, to boot, their insurance was almost used up for the year. Ada’s husband liked to think that these things didn’t enter into patient care, but he felt they had to play a part.

The doctor told him he certainly was welcome to be present, but his schedule didn’t allow him to name a specific time for the meeting. That would depend on Ada’s state of mind.

Widowed, Gav had given his young son his medical power of attorney. Gav’s situation was similar to Ada’s. The difference was that Gav was unresponsive and could not make decisions for himself. Just recently, Gav had become very frail, as well. The doctors had given him just weeks to live, even before this new infection had set in. Gav’s young son talked to the doctor about his father’s desire to have everything done to keep him alive. The doctor explained that in his extremely frail condition, should his heart stop, CPR would break ribs and cause more harm than good. He convinced the young man a DNR order was in his father’s best interest.

Gav passed away a few days later. His son is still wondering if his father would have lived a little longer if he had made a different decision. He knows the doctor gave him the best advice from a medical perspective. He just wonders what a doctor’s outlook entails.

Would the doctor have suggested the same thing if it was his father that was lying there? Meanwhile, he mourns his father and knows he would feel guilty, no matter what his decision would have been.

We all have tunnel vision. We see things and decide things based on our knowledge and experience. When dealing with the chronically ill, doctors often see things differently than family. This may be especially true at the last stages of chronic illness. This does not mean that we are necessarily being manipulated by the system or by the doctors. But it does mean that two people rarely see things in the same light.

That’s why, whenever possible, a trusted second opinion especially from someone with experience with chronic illness might be wise. Consulting a rav who specializes in these types of decisions is a necessity. Their input may not change the course of action you choose, but it may go a long way to giving you peace of mind later.