‘It is my bad luck that this happened to me.’ No, you should rather say: ‘It is my good luck that, although this has happened to me, I can bear it without pain, neither crushed by the present nor fearful of the future.’ ~ Marcus Aurelius, before AD 180.
[Note: I made the imagery for my graphic black and white (then sepia), and pixelated the appendix, in order to spare you the grotesqueness. If, for whatever reason, you’d like to see the un-pixelated version, click here. I always have to have an image with my posts.
I also didn’t name the country I’m in, nor the hospital in question. What with COVID-19 having announced it’s ghastly arrival, I may need their services again. That, and any institution or government that deserves criticism likely doesn’t tolerate it.]
Sometimes timing is so goddamned perverse it’s hard to believe there’s nothing pulling the strings behind the screens. Right when the government here shut down schools and finally got serious about COVID-19, and when you aren’t supposed to go to public venues, and the last place in the world you want to go to is a hospital, I get appendicitis.
It’s considered a minor operation, I know. It’s nothing compared to the auto accident an artist friend recently endured, and it’s not as bad as getting a severe case of COVID-19! But, sometimes I do more personal posts that show I am indeed human, and like Shylock, if you prick me with a pin, I bleed.
There’s the part about being overcharged and paying for stuff I didn’t need that grates on me because it makes me feel like a sucker. I have some more observations related to this experience regarding free will and determinism. I’ll tell you what it was like having my first operation, and in a foreign country.
I woke up in the wee hours with stomach pain, kind of like my stomach was filled with liquid or air. It was an odd sensation, quite high in the stomach. By the morning it hadn’t improved, and I assumed I had food poisoning, AGAIN! My girlfriend, Lani, thought it might have been the ice in the drinks from the day before.
The pain moved lower and lower, and it felt a bit like I had a bunch of un-chewed cauliflower in my gut. Slowly the pain migrated way on the right, low down, and intensified. Unlike every other time I got food poisoning, I wasn’t vomiting profusely, and didn’t have diarrhea. In the late afternoon the pain still didn’t go away, and I finally vomited. Just dry heaves and bits of charcoal from some tablets I took to combat food poisoning. No wild, passionate eruption, as is usually the case.
I finally looked up my symptoms, and to my grave disappointment I had the classic signs of appendicitis. If I waited, and my appendix burst, I would be in much more danger, and I could even die. I thought to wait a while and see if it got worse, but Lani is more of a take-care-of-things-immediately individual, and she started making phone calls to see if someone could give us a ride to the hospital. One of our regular local taxi drivers was available, so away we went, just to play it safe.
I didn’t think I had appendicitis (and I’m still not 100% sure, or even 95%), but with death a possible outcome, I couldn’t risk not getting checked out.
Since it was already around 11 pm, we had to go to the ER. I can’t honestly say that as soon as I told them my symptoms the greedy gremlins invisible to the naked eye weren’t licking their chops. One of the reasons we chose this hospital is two other teachers at my school had appendectomies there, and they’re still stomping around. On the other hand, it’s a small school with just six teachers, so there’s already a conspiracy theory going around that you go in there for one thing, and they tell you, by the way, your appendix needs to come out. In my case, though, I was coming in specifically because of the likely appendicitis.
I was weighed, my blood pressure taken, and height established. I didn’t have to wait long to be let into the inner sanctum of the ward, as it wasn’t very busy at all.
Inside they immediately put me on a gurney, which Lani and I thought was a bit premature. A young nurse with “student” stitched onto the back of her uniform managed to insert a catheter for an IV, and take a couple vials of blood, while not losing too much more blood spilling all over my hand.
We waited about an hour for the results of the blood test, though they never told us what they were, exactly. An orderly wheeled me through some corridors to give me a CT scan, which was a new experience for me. As soon as I saw the machine I knew I was going to feel that scan in the pocketbook.
Afterwards, the orderly wheeled me back to my gurney station, coughing several times overhead with startling vigor. He was wearing a mask at least, but I was reminded that I wasn’t. I was never offered a mask, though everyone else was wearing them. We wouldn’t want my nerve ends to have any protective coating against additional life-threatening concerns, like getting COVID-19 while having an operation.
Not long after, a middle-aged male doctor appeared to tell me I needed an OPERATION! My girlfriend’s eyes became saucers, and I sunk into the gurney.
A woman brought an expense sheet with a sum exceeding my life’s meager savings. The prospect of a new computer I’ve been patiently putting away for, not to mention the cataract surgery for my left eye, suddenly vanished. I said, “I can’t afford it.” The woman assured me my insurance would cover the vast majority of it, and, I thought, what the hell else am I going to do? I couldn’t storm out flinging open the doors like a gunslinger existing a saloon, and shout, “F@#$ this shit!” My health, and possibly even my life were on the line. We could go to a cheaper, albeit sketchier hospital, and start over, but if the insurance WOULD pay the lion’s share, we could cover the rest. I signed my soul on the dotted lines, establishing I would pay the exorbitant fees, assuming there were no complications that would make it larger, of course.
That said, the price compared to having a similar operation in the States was a fraction of the cost (though so are my earnings working here a fraction of what I’d make back home).
Don’t get the impression that anyone wasn’t nice. All the people involved were lovely, at least on the surface, and I’ve never had so many people fuss over me in my entire life. If I were just a portion as rich as they thought I was, I would only be worried about the quality of the care. Even if they gouged me — financially speaking, ’cause they definitely were going to literally gouge me — I wouldn’t care. This country is a hot spot for medical tourism. You could say it’s my stupid fault, and bad life choices, for pursuing art instead of money, for moving overseas to see the world, and the list goes on. The point is that the people were uniformly kind, gentle, attentive, and reassuring. They also spoke quite passable English, once they gave up on speaking the local language to my girlfriend, who can pass for a local, but was born in America.
On the way to the operating room we did a pit stop for a chest X-ray, which took just three tries, because the first two times they did it they didn’t have the gurney lying flat. This would have been a bargain — three times the radiation! — if, to judge by the extra costs on my final tally, I hadn’t paid for each zap. I’d asked why I needed a chest X-ray at all, and I don’t recall an intelligible answer. By this point, I was really trying to not be so goddamned suspicious. When you are putting your well-being, and a lot of potential suffering into someone else’s hands, it’s just that much tougher if you are second-guessing them the whole way. After bolstering my system with radiation therapy, the nurses took me to the operating arena.
My doctor, anesthesiologist, and most the nurses were women, as far as I could tell. Only just now do I remember being introduced to a tall male doctor early on who was going to be my doctor, or was it the middle-aged guy that first enunciated the dreaded word operation? My confusion might have to do with the anesthesiologist saying she was my doctor, which would be true either way, and my trying to piece this together from memories immediately prior to, and after being sedated. Note that when you are put under, you are essentially put into a temporary coma where you are paralyzed and can’t form new memories. It doesn’t really matter who the doctor was who cut me open and extracted the appendix: whoever it was did it properly, as far as I can tell.
As my woman doctor was giving me some preliminaries, while I looked up at her, helpless, I debated whether or not to tell her I needed the bathroom. Not because I was nervous, because I wasn’t. I had to pee like Sea Biscuit, which struck me as kinda’ odd, because all day I could barely urinate, which I considered one of my outstanding symptoms. I shelved any notion that I might be coming out of whatever was ailing me, and they were operating fast before I felt better. After all, they’d got blood results and scan results that confirmed my appendix was in deep shit, and about to explode with it (not that I’d ever seen the evidence with my own eyes). I worried if they cut me open urine would spill out, or I would pee myself? That would be embarrassing. Since I didn’t want to come out of the operation in an awkward situation, on top of everything else, I asked, and she allowed me, quite naturally, to take care of business. It was, curiously, a record-breaking stream. I signed a waiver in case anything went wrong due to being anesthetized.
I got back in the gurney and faced up again. I saw the words OPERATION ROOM appear, in English, as I was wheeled along. I didn’t feel fear, apprehension, nervousness, nor tension. You might say I had resignation. I could even die, though if I were unconscious when it happened, that would be a very gentle departure. Generally, I had faith they’d do a decent job, patch me up, and I’d be alright. So, I just lay there like a stuffed animal, feeling nothing because I couldn’t risk feeling anything. Intellectually I knew I should be fine, but experiencially, never having been cut open before, beyond those two doors lay uncharted territory.
I saw groups of lights which reminded me of a set of dragon fly eyes. The nurses stretched out my arms, crucifix style, and fixed them in place. I was already on the IV, and a clamp was put on my right index finger to keep my pulse.
The anesthesiologist gave me instructions about when I would awaken. They would be putting tubes down my throat to help me breath. [Only days later did I figure out that because the anesthesia would paralyze me, those tubes would be forcing my lungs to operate!] That sounded thoroughly invasive, so I consoled myself that I’d be blissfully unaware when it happened. But, she continued, when I wake up, I should keep still, and definitely not move my head from side to side. I should open my mouth so they could remove the tubes.
Everyone seemed pleased I could speak their language on a rudimentary level. One of the nurses leaned in close and teased me about a scar I have.
The anesthesiologist placed an oxygen mask over my mouth, and told me to breathe. I was in such a wet-rag state that she had to tell me to breathe 100%. I felt weighted things being placed on my legs. Then she told me to go to sleep.
I breathed in some more and there was no effect. I wondered if the anesthetic wasn’t working for some reason, and I couldn’t taste anything unusual in what they were pumping in the mask. I closed my eyes and then saw a round shape with vague, undulating deep red lines, and knew I was going under.
I awoke suddenly, shaking uncontrollably. I was surprised I was so cold, and I felt like a frozen bird skewered on a stick, faintly flapping. I saw the dragonfly eyes, the white and blue of uniforms. The doctor said my name and something to me. They put a blanket over me and I felt better. I don’t remember anything about the tubes being removed from my mouth.
They rolled me out, and Lani’s face appeared looking down at me. She asked if I was OK, and I said I was cold.
The nurses rolled me into the intensive care unit. One of the nurses squeezed my left foot: a small gesture of support I remember through the blur of having been sedated. The nurses and orderlies seemed kind, and they seemed to care. I was put on oxygen, and my IV continued to drip.
I asked Lani to take my picture.
“Yeah. For a blog post.”
That pic, of course, is the center of the collage at the top of this post. [Note: it’s not my good side.]
When my IV — filled with essential salts, vitamins, and electrolytes was empty — an annoying alarm went off in three ascending beeps, and it kept going off until a nurse came to the rescue.
I told her, “I have to throw up”.
She just looked at me.
She still didn’t understand.
I gestured with my hand stuff coming out of my mouth.
Still didn’t get it.
When I started hacking into the oxygen mask, trying desperately not to fill my mask with puke, she figured it out and got me some sort of bag, which I then gacked into several times.
My Hospital Room
Soon they rolled me to a large private room, where I was rather painfully helped into my bed.
My girlfriend, having gotten no sleep, went home to take care of various things, and I faded in and out, still a bit delirious from the anesthesia, painkillers, exhaustion, and whatever else. But I was not able to rest, because they took my blood pressure with the arm tourniquet so frequently I thought it was overkill, and when that wasn’t going on, the IV equipment was beeping for another bag, and another stack of bills.
A phone call!
I sat up and reached over to the vintage phone, and a woman told me they’d contacted my insurance, and one of us was going to pay 77,000 and the other 44,000 of the local currency. I wasn’t sure what the insurance paid and what I paid, but either way it was better than I expected, and I was in too much pain from suddenly leaning over the railing to find the phone to ask for clarification.
My manager from the school brought Lani back, and they tried to sort out the bill and insurance. After calling the insurance company, they denied ever receiving anything from the hospital. This clever strategy on their part would be maintained throughout my stay, so that we couldn’t contest their paltry contribution until I’d already paid.
The new figures were different from the what the woman had said earlier. Now I was to pay 90,000 and the insurance 30,000. Once again, being right about my more cynical predictions was the thinnest layer of consolation when faced with the fact that indeed, this was going to clean me out. They also said they wanted to keep me until Thursday, for a whopping 4 days. Lani had come back with the conviction that the next time she went home, she was bringing me with her. She wanted me out ASAP and started making a bit of a stink about it, and thank God.
This is when we also received the news that our school would be shut down for two weeks (at least), in which case we wouldn’t be making any money for a stretch, if not the foreseeable future. Spiffy!
The finances are boring, but the problem was that all through my time at the hospital I felt something was fishy, and I couldn’t really trust that I needed certain procedures, and I was worried about each additional, robust cost.
The middle-aged male doctor paid me a visit, and everything was going fine until he said, “We found something.” What the hell? As if getting cut open for the first time wasn’t enough, before I’d even recovered, he had something worse, and doubtlessly much more expensive, to serve up.
“The CT scan showed a cyst in your liver.”
I was getting a little angry. Couldn’t this have waited until nearer checkout? It could be nothing, he told me, and I didn’t have symptoms, but he wanted to consult with a specialist. He dropped the word “operation” again!
“I don’t have money for any more operations.”
He clarified that he wasn’t suggesting one now, but that he’d like to investigate it, and keep me under observation. My translation of this was, charge me an exorbitant consultation fee and for repeat visits by striking fear into my heart.
I just thought that without symptoms, it wasn’t an emergency, and contrary to the flattering impression everyone seemed to have of me, I was not in fact a Duke or Prince of some small European country, who indulged in a collection of solid gold lawn ornaments (jewel encrusted, mind you). If there’s a chance it’s benign, I’ll take it.
When my girlfriend returned — oddly, almost all significant visits occurred when she was not present — she laughed off the cyst. She searched it online and started reading off that liver cysts are not only common, they are very rarely cancerous, nor do they interfere with liver function.
You don’t sucker punch a man in the gut after an appendectomy.
On the bright side, if they were going over my scans with a fine toothed comb to find anything to latch onto, they didn’t find squat, including in any of my three chest X-rays. A clean bill of health, that!
Making Our Getaway
The second night in the hospital didn’t include more than sporadic blissful moments of sleep. The blood pressure checks, temperature checks, changing of the IV, adding antibiotics and painkillers, and room cleaning guaranteed no more than minutes of unconsciousness if we were lucky.
The third time the blood pressure machine was wheeled in to choke my left upper arm, Lani got annoyed, stood up from the couch she was attempting to rest on, and asked the nurse, “Is this necessary?”
The nurse didn’t seem to understand?
Still fell on deaf ears.
The sleeve went over my arm, and my bank account was squeezed, letting them know for the dozenth time that my blood pressure was actually quite impressive (for my age, my blood pressure boarders on “athlete” status), and I had no fever.
Into the next day it was the same routine recycling itself. The insurance company was taking evasive maneuvers. Liquids were being piled on my IV post. Unnecessary room service came through. I got another wet towel bath. We tried to convince them that we couldn’t afford another day at the hospital, and we wanted to go home. Lani was getting embarrassed having to repeat over and over that we didn’t have that much money.
I explained to one nurse while she was changing my IV that the insurance wasn’t paying for diddly squat (I didn’t use those words), and we couldn’t go back to work, so we really needed to leave as soon as possible. She said she’d tell the doctor.
While Lani was making use of the shower, another doctor came in, this one a woman I didn’t recognize. Hard to tell when everyone has a mask on, and I only saw some of them looking down at me, not at a more level angle. Her English was very comfortable, and she explained that my appendix had perforated, and it was going to burst. There was puss spreading in my intestines, or something like that.
This I found reassuring. If I was being overcharged, kept from sleeping a single full hour since the operation, and I was having to be in a constant state of suffering, well, the operation itself, which was a success, was absolutely necessary and very well could have saved my life. This would also explain why I got the more invasive of the two standard operation procedures: not the three incisions, but the “open operation”.
It struck them as funny that I seemed happy about my earlier dire state, and after they’d left, Lani asked me what was the laughing about when she was in the bathroom. It could have been a load about the perforated appendix, though. They’d given me a picture of it, and, it looked disgusting, and kinda’ alien, but not like it had burst. I didn’t have the excruciating pain associated with a burst appendix, either. Could just be another dressing up of the truth, and if they were lying about my appendix being perforated…
When the next round of IV came in, Lani put her foot down. Not only was it never attached, she managed to get the nurse to take the IV out of my hand.
Within 15 minutes I started to become myself again, though this may be just because I had the freedom to shuffle around without carting the IV stand along with me.
The kindly, middle-aged “we found something” doctor reappeared to dress the wound, and cleared me to go. I thought he’d given up on the liver cyst angle, but he brought that up again, as Lani made dismissive faces and gestures behind his back. Not satisfied, he added that they’d sent my appendix in to be analyzed, to make sure it was an infection, and not CANCER!
Y’know, my biological father died of cancer — which started in his pancreas and spread throughout his body — at age 52. I’m 54. I just don’t appreciate that kind of humor. Just a little too close to the bone to be riotously funny. Cancer my ass!
I understand it’s standard procedure to diagnose the organ, but did he have to keep dropping the “cancer” bombs? He said we could discuss the results when I returned in a week to get the stitches removed.
The Final Kick in the Teeth
An orderly came in a while later with a nifty bag chock full of meds. Yup! She pulled them out of the bag, one by one, like they were gifts, and explained what they were for.
There were not one, but two courses of antibiotics. Two sales are better than one, I guess. There was a daily pain killer. There were supplemental pain killers. There was a daily anti-acid pill. And then there was my favorite, the anti-flatulence pills. Finally came the paper to sign, agreeing to pay for them all. I made noises about not needing the anti-acid or the anti-flatulence, but it was useless, and Lani’s eyes were saying, “let’s get the hell out of here”.
“How much does the medicine cost?” I politely inquired.
“I don’t know,” The orderly clarified.
My calculation, since additional sums were piled onto the original estimate, despite no complications I’m aware of, is $500. I definitely wouldn’t have paid more than $100 for anti-flatulence pills! And, so far, I haven’t taken a single anti-acid, and I only took one anti-fart pill, but I forgot you could chew it and swallowed it hole. Didn’t need either of them. And the pain killer? No better than paracetamol. The antibiotics? Tens of dollars a piece at a pharmacy outside the hospital.
I got a wheelchair ride — another first — to accounting. Yeah! We tried to pay with my American credit card, but it wouldn’t go through, for whatever reason. My bank sucks! My girlfriend got 60,000 out of her account for the time being, and my manager loaned us the other 40,000. I was wheeled out of the hospital, a half day early (2.5 days early if they were able to keep me down for 4, as they wanted to).
If Lani hadn’t stood up for me, I’d probably have been there another day.
When I got home we opened the sliding glass doors to my planted balcony, I laid on the bed, the fan was angled on me, and I felt immeasurably better. I was finally home
and in one piece!
Determinism, Free Will, and Appendicitis
Philosophers have been debating free will for thousands of years, and more recently neuroscientists, scientists in general, and a host of others have joined the fray. I’m a firm believer in free will, and have a rigorous argument for it, which nobody has yet been able to defeat.
As it happens, I was debating some trolls on the topic in a philosophy forum when I got the appendicitis. They couldn’t score a single point on me, but were hoping to catch me on anything at all, and then declare that since they got me on that, not only had they won the battle, they’d won the war.
In a nutshell, arguments for determinism are very, very simple. Every physical thing is bound by physical laws; everything that happens is the unavoidable consequence of the preceding one; our brains are physical; our minds are created by our brains; therefore our every thought and decision was predetermined; and some argue consciousness is irrelevant. Done deal; slam the books closed; nothing to see here; go home; we are automatons! True or not, it is a terribly unsophisticated argument any wingnut can wrap his or her predetermined mind around.
The more complex counter I make puts consciousness back into the picture, and it’s quite something to leave out! While the underlying physical process of thinking and decision making are controlled by the laws of physics, how the mind thinks intellectual is not. We use language, logic, reason, associations, imagination, and so on in order to make decisions, not blind physical forces. If something is animated at all, is alive, it is no longer just a domino falling in accordance with prior events. Something obviously much more complex is going on. But if something is additionally intelligent, self-aware, and uses abstract thought to make decisions, those decisions are not the inevitable consequence of blind, unconscious, unthinking, physical forces.
Despite my better argument, I found myself completely at the mercy of others, nature, and events outside of my control, for two grueling days. The most outstanding example was when I was splayed, in a temporary coma, on the operating table, and I was pierced by a blade an inch deep (according to Mr. “We found something”) in my soft white underbelly. Of course, my consciousness was manually shut off, which would make free will impossible by my own argument. But even going into the operating room and seeing the sign overhead, and waking up shaking, allowed of very little, if any, agency. I may as well have been unconscious for most of my stay.
Free will or determinism, whether we are the body or the mind, may be an unsolvable conundrum in which both are true, even if incompatible. Nevertheless, I will bank on me NOT being that slab of pink and red flesh extracted from my belly, but rather the epiphenomenon of the state of consciousness and the contents and actions of the mind. And now that my mind is up and running, I can make a conscious decision, such as, for example, to NOT go back to the hospital to get my stitches removed, but recruit Lani to be my trustworthy nurse and remove the stitches for me when the time is right.
The Body On Loan
I had an idea that our bodies are not ours exactly, and it is our responsibility to take care of them, like someone’s pet horse we’ve been paid to look after. Oddly, this made sense, though the argument that your body is your own and you have every right to do with it whatever you want is the default reasonable argument, and one I would tend to favor in terms of law.
However, if we were to think that mind is the master over matter, would mind then be beholden to take proper care of the matter which was in its purview, namely its own animal body?
People take better care of their pet’s bodies than their own. Would any reasonable person give their dog cans of beer a day? How about a bag of Cheetos?
Since then, I tend to think of my body as something entrusted to me to take good care of, and it’s one of my first responsibilities as a conscious entity. I stopped buying sugar many months ago, then switched to non-fat milk, and then about 5 months ago gave up meat and dairy. I swim, go to the gym, stretch, meditate, and even do cardio using the apartment’s staircase.
Now I can’t exercise for up to a month, and my body chemistry is shot to hell with all the antibiotics. This whole ordeal was very hard on the body, but it seems to have been for the overall good.
I remain committed to taking good care of the beast entrusted to my care.
My Wicked Residual Anesthesia Dreams
When I was finally able to lie down to sleep in my own bed at night, and be comfortable, something surprising happened. After I closed my eyes for just a few minutes, images started to appear. It was as if the barrier between the conscious and subconscious had become more porous. I could watch figures emerge on the inside of my eyelids while still awake. I saw a lot of mutants, and some great images I could use as inspiration for art.
I had vivid dreams, and during one I became lucid. I was washing my hands under a faucet, and the scintillating water contained long, eel-like, miniature, iridescent fish. I studied several in the palm of my right hand. I was in a disheveled, brightly lit bathroom, as if in the corner of a biology lab. There were plants and natural light.
On the walls I noticed some colorful geckos, but species I didn’t recognize (I’m a lizard expert, and have kept many species as pets in my younger days). It was about here I realized I wasn’t in consensual reality. I didn’t think I was dreaming, because this didn’t have the quality of a usual dream, either.
On the tiled wall, on my left, there was a brilliantly colored purple frog, like a large poison dart frog. Fully conscious, I looked at it intently, and marveled at its existence. I examined the tactile texture of its skin, its shifting pattern, the shape of its pupils, and the metallic folds of its irises. Dreams sort of just happen to you, but here I was very present and self-aware, critically studying the minutia of my physical environment, and it was weird, psychedelic, and beautiful.
I wondered if I had died, and if this were the afterlife: a fascinating universe of reality conjured by mental forces, but not apparently my own. I didn’t see myself as creating the frog. This is a really curious confrontation of the conscious and the subconscious, and collision of two mental spheres, like membranes touching.
I’ve had lucid dreams before, and even the type where you say, “Oh, hey, I’m dreaming, let me just take advantage of this and soar up into the sky and fly around a bit”. But this was different. If lucid dreaming gets this amazing, without having to have your appendix out, it’s something I want to pursue more! If that was a glimpse of the afterlife, I have something to look forward to.
I thought at first it might have been the days without sleep that caused the dream, but later research leads me to believe it’s the after effect of the anesthesia. Maybe both.
And in the End
I finally thought to look up the costs for an appendectomy in this country online, and while the rate I paid was in the upper quarter, it is not unusual for what foreigners generally pay. That makes me feel a bit better, but doesn’t necessarily mean the hospital didn’t gouge me twice, it just means that the industry in general price gouges as a general practice. Either way, it was a bargain compared to what it would have cost in my home country.
The doctor with the possible cancer lines was probably just doing his thorough job. I did like him, and everyone else. I’m cured, and that’s really the important thing.
Days after the surgery, I’m recovering swiftly. I can’t say I am living up to the great Roman Emperor, Marcus Aurelius’s advice to himself which I quoted [his meditations were never intended to be for the public], that is, considering this whole ordeal “good luck”. I do feel a bit the wiser and more mature for having had the experience. My breadth of experience and understanding has increased. And, with the kind assistance of my mother who immediately sent me a third of the expense, I probably have enough money to see me through the difficult weeks or months ahead.
I am perhaps a bit more all too human.
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