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Posts Tagged ‘nurse’

So.

The last time I posted here, August 10, 2010 (over a year ago), I mentioned I was going on a little hiatus.  A hiatus is usually a very brief delay, but in this case it lasted … over a year.

However, I’m back!  You’ll notice the title of this blog is no longer “Adventures in Nursing School.”  That’s right — I’ve since graduated, passed my boards, and am currently looking for a job, either a) in a NICU (neonatal), or b) in a Community Health setting.

Anyway, since we last talked (or interacted, or saw each other’s comments, or whatever), I’ve become a member of a growing community of fitness/nutrition enthusiasts, and have started researching and trying to understand (key word, trying) the paleo/primal way of living.  As a part of this, one of the people with whom I’ve become friendly is Jenn, and she and I will be holding each other accountable for the month of September, which we are treating as our own personal 30-day Ancestral Health Challenge.

These 30 days will include eating primally and moving primally, and we can’t wait.  I’ll link to Jenn’s blog at some point soon, but in the meantime, keep an eye out for more blog posts to follow.

I’ll be writing more about my job search, living in Philadelphia, and of course, nutrition (maybe even with photos).

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So was that fun for ya yesterday?  Was it?  Big props go out to my buddy and fellow student nurse Will over at Drawing on Experience who provided the blog entry for me yesterday.  Also, thanks to E1 for pointing out tonight that I had still not, technically speaking, posted any blog entries in 3 months, even with yesterday’s post.  Thus, here I am posting!

Seriously?  It’s been 3 months since I last posted something?  Wow.  Just … um … wow?  Not sure I really have any words for that kinda dedication to my blog, right?  Right.  Yeah.

So let’s see, let’s get reacquainted.  Hi there, I’m Nurse Kenny.  I’m a student nurse who has finished his first year of nursing school, believe it or not, and is prepared to start his second year in the Fall.  The last we talked, I was getting ready to start my rotation on the Maternity floor.  Yeah, that was in mid-March.  Since then, a lot has happened.  Let’s recap and make a long story short, shall we?

  1. I completed the 6 weeks on the Maternity floor.  More on that later on in another post.
  2. First year of school done … happy with my grades … blah blah blah.
  3. Finished my first ever Relay For Life with the American Cancer Society.
  4. Started riding my bike quite a lot more.

And lots of other, mostly boring stuff.  So another time I’ll start posting a bit more about my Maternity rotation, because it was indeed quite eventful.  I’ll just say, I enjoyed it a ton.  Really.  Being serious!  Good times.

Ok, so that brings me (in a roundabout sorta kinda way) to the present.  Right now I have a position as a Nurse Extern in the hospital affiliated with my school here in the city.  I’m actually working on the very same floor where I did my cardiac rotation:  it’s a telemetry unit called the ICCU (Intermediate Cardiac Care Unit).  It’s filled with people who are mandated to be on cardiac monitors (maybe they’re in heart failure, maybe they’ve had a heart attack, etc.).  Also on the floor are folks who are either a) waiting for heart transplants or b) have just had heart transplants.

Immediately after getting a new heart, they’re transferred to the CCU (Cardiac Care Unit), which is like an intensive care unit for them.  After they’re more stable, they’re transferred to our unit.  Also, anytime in the future a heart transplant patient has to come to the hospital for any reason, they’re admitted to our unit.

So … this all means that, for the remainder of the summer, I’ll be posting primarily about my externship (which I’ll have until I graduate — I’ll just be committed to every other weekend during the school year).  I’ll sprinkle in lots of stories about my Maternity rotation, too.

I’ve been “orienting” to the unit, and just getting the hang of the logistics of it all.  This week I’m working Tuesday/Wednesday/Thursday on a 7AM-7PM each day, and then I’ll be done my orientation and will be on my own!

Today’s highlights included:  collecting drainage from a JP drain to send to lab; changing gowns a million-gazillion times on a middle-aged woman because she had tube feeding going and was a general mess; being able to tell a fella he wouldn’t have to get his insulin before dinner because his sugar was at an acceptable level, and then seeing the smile come across his face; working with 2 other awesome externs and trying to figure out how best to get someone from Bed A (with a broken bed alarm) to Bed B (brand new bed) without clogging up the whole system — how many nurse externs does it take ……………

See you all soon.  Welcome back!

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  1. I am done with my telemetry rotation in the CCU.  I feel pretty good about this, and feel like I learned a lot about how to be a good nurse.
  2. After a few hundred hours in the hospital, I finally removed my first foley catheter in a patient tonight.  How did it take that long?
  3. Nurses who show me how to do things are awesome.  Nurses who instruct me how to do things are awesomer.
  4. I think a good name for a band is “Vasolex to the Max.”
  5. I am now an expert in making a bed with a human being in it.
  6. You may think Pepsi Slurpees are indistinguishable from Coke Slurpees … but you’d be wrong.
  7. The best way to tell you’re finally comfortable with a hospital floor is when you know just how to hold the styrofoam cup under the ice machine so the ice doesn’t spray all over the floor.
  8. Over the last 6 weeks, people have told me I look like Fred Savage, Tom Hanks, and the dude who plays Sheldon on The Big Bang Theory.
  9. There’s no real good way to ask a patient when his last bowel movement was … so ya just have to ask it.
  10. It feels ridiculously great, as a student nurse, when you can help teach a patient’s family something about their loved one’s disease.

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Tomorrow.  Monday.  2nd semester out of 4.

Time to get back into it.

Update tomorrow night!

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I do believe it’s officially that time of the semester where everyone gets cranky, we’re all tired, and we all feel like we’re just … stuck.  I certainly do.  It’s a time when there are loads of assignments due, gobs of exams to study for, and presentations to give.  We’re all feeling the stress and it’s showing.

Time to take a deep breath and settle in for the next 3 weeks.

I’ve also decided not to blog about my recent patient — it’s just too difficult to try to explain what was going on without violating this person’s privacy.  In any event, it was a very educational 2 days of clinical on Wednesday and Thursday.  I learned a great deal about people.

One funny/disturbing/typical story:

It was near the end of our shift, and we had about 5 minutes until post-conference (where we all meet in the staff lounge and discuss our patients — we’re practicing presenting a patient in case the doctors making rounds need to know from us what’s been happening with our patient).  I should preface the rest of the story by saying that, on our floor, we each have one patient for the duration of our shift, and only one.  Not all of the patients have a student assigned to them.  Anyway, I was standing at the end of the hall doing some last-minute computer charting of my patient, and out of the corner of my eye I see a hard-charging person.  I glance up and it’s the mean, nasty, scowling nurse who gives off bad vibes.  She’s moving quickly, and she looks up to my right, and I notice that the room nearest me has its call bell (white light) blinking, but I don’t hear it ringing.  Normally, the student to whom this room was assigned should have been notified and gone to see what the call bell was.  Of course, it wasn’t a student — it was AngryNurse.

She looks at me and says, with a decided sneer at my uniform, “What … students don’t answer call bells anymore?”  I replied in an even voice, “I’m sorry, I was charting and didn’t even see or hear the call bell for that patient’s room.”  To which she huffed and puffed a bit, and said with disdain, “Well, when I went to nursing school we would go running for every call bell, and wouldn’t be caught dead not answering one.”

Well.  Excuuuuuuuse me (said in a haughty tone).  I really really really really wanted to respond to AngryNurse, but I bit my tongue.  I’ve discovered there are definitely 3 types of nurses on our floor when we’re there:

  1. Awesome Wants to Teach Nurse:  he/she seems to enjoy us being there; doesn’t mind telling us why he/she does things a certain way; says “hello” and “goodbye” to us; is happy that we’re helping them at all with mundane tasks.
  2. Indifferent to the World Nurse:  he/she seems to kind of drift along aside the students, and doesn’t seem to care either way what we do; teaches if it’s a last resort, but prefers to just do things on his/her own and not involve us; says “thanks” when we do something, but doesn’t talk to us otherwise.
  3. AngryNurse:  seems to want to slaughter us and send our bones and tendons and organs to the farthest reaches of the globe and proudly bellows how bitter he/she is to the world and generally makes us want to throw up all over the nurses’ station.

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###WARNING### — this post will contain very graphic description of surgery and operating room stuff.  If you’re not cool with reading that, stop reading now and go here.  This means you, S, J, R, M, and Y.*

*I totally made these people up, by the way.  Unless your name starts with S, J, R, M, or Y, and you’re easily skeeved by blood and guts.

Let’s try writing in the present tense for this entry.  Change it up a bit.

So.  Let’s see.  Friday morning I wake up at 5AM.  This is early.  Normally I’m dreaming about car fires or delicious little impossible cupcakes at this point.  But I wake up to my alarm (set to 93.3 WMMR, because it’s the only station I receive clearly on my 20-year-old clock radio), shave, shower, eat some breakfast (per my instructions … don’t wanna be passing out in the OR), and make my way to the hospital.  This time I am in the main hospital building, which houses some 30 or 40 operating rooms, I believe.  I take the elevator up to the floor with some of the ORs.  I knock on the door of the OR nursing suite.  “Hello?” I say to no one in particular.  It is 6:45AM, and I don’t see anyone here.  Finally, a woman sees me and says, “Ok, grab some purple scrubs (yes!), put them on in that bathroom, lock your stuff in the locker, and wait in that room over there across the hall.  Someone will come to get you.”

Hmm, ok, I think, this isn’t so bad.  I change into my sweet purple scrubs, lock my stuff away in the locker, put the key around my ankle, and turn the corner into the OR lounge.  Yikes.

There are about 40 people in here.  All wearing either teal or green.  All drinking coffee and eating danish or donuts.  All talking to each other.  I stick out, but people ignore me.  I sit down on a couch and wait.  To my left is a bug zapper.

Wait, a bug zapper?

To my right is another bug zapper.  I can only assume, given the vast amounts of food and drink to be seen in this lounge, that they’ve had a little problem with lil’ critters.  Hence the bug zappers.  I assume.

At precisely 7:01AM, all the green- and teal-clad folks begin checking a master sheet, file through a door, and disappear down the hall.  I take it that these people are all nurses and techs and have disappeared to start the day.  I am left alone in the lounge, watching the sad news from Ft. Hood.  I am tempted to stuff my hole with donuts, but I resist.  At 7:30, another student comes in and we chat.  She changes into her purple scrubs, and we sit together for a while.  At around 7:50, a nurse comes over and introduces herself, saying she’s sorry, but someone called out sick, and she’s been tasked to take care of us.  For the next 15 minutes, she goes over the “house rules.”  This includes things such as:

  • Do not talk to the surgeons unless they talk to you.
  • Do not touch anything blue or clear plastic.
  • If you feel faint, sit down immediately and tell the circulating nurse.

So after these rules are hammered home, she says, “Ok, let’s go, follow me!”  She gives us booties for over our shoes and a hairnet/cap.  She is perusing what looks to be a master list of all the surgeries scheduled for that day, and is trying to figure out where to put us for the morning.  We follow her downstairs and to the next building (which is connected with a bridge).  And then we finally enter the OR suites.

At this point we are standing in a very long hallway, with ORs on either side.  The nurse gives us a duckbill mask here, and instructs us to wash our hands.  As I’m stepping toward the giant sinks they have for the surgeons to scrub in, I hear the following:

WOMAN #1: Oh man I gotta go wash my eye out!

RANDOM MAN:  Why, what you get in it?

WOMAN #1:  Oh, just some blood.

Our friendly nurse says we should always wear that mask inside the OR.  She also gives us a flimsy-looking coat of some sort, because it gets very cold inside the ORs.  Lastly, we are told to wear disposable plastic glasses to protect our eyes.  We follow this nurse down to OR #5, at which she drops off the other student.  She wants me to go into OR #3, and we enter through the door.  Five people turn around and stare at me for a few moments, then turn back to the patient, who is lying on the table, completely under anesthesia, with her abdomen exposed.  They’re about to start a laparoscopic resection of the colon.  Cool!  I think this is my lucky day.  Then things turn sour.

The surgeon seems upset.  He’s going on about some machine that isn’t working properly, and they can’t start the operation.  The nice nurse who’s been taking me around says, “Ok, let’s find you another room — this one’s quite ornery.”  She then says, “I think there’s some ortho surgeries going on, let’s go down there.”

We knock on OR #36, which seems to already have a surgery going on.  I’m allowed in this room, introduced to the circulating nurse, who will be taking care of me here all morning, and then the charge nurse disappears.  Ok, this is it.  I’m alone now.  On my own.  Gotta keep it together and be professional.

I’m introduced to the people in this OR.  Right in the middle of their surgery.  From left to right:

  1. Circulating Nurse, who is the only one not in the sterile field.  She wears a mask and cap, but normal scrubs.  No gloves.
  2. Scrub Nurse, who is in the sterile field.  She seems to be standing next to the instruments and handing them to the surgeons.
  3. Scrub Nurse, who is in the sterile field.  He seems to be manning the hooks and retractors.  That seems to be his only job.
  4. Chief Resident, who is in the sterile field.  His job seems to be opening the case, making the incisions and getting started.
  5. Registered Nurse First Assist (RNFA), who is in the sterile field.  She is manning the suction and other tools.
  6. Patient, who is in the sterile field (duh).  He doesn’t seem to know what’s going on.

I should mention here that this OR is different-looking.  They do only “joint” cases here (involving joints and bones and such).  Because of this, they use some sort of strange air-flow system.  All the people in the sterile field, which is represented by a giant box drawn on the floor (I was instructed to never step over this line, by the way), are wearing these futuristic-looking helmets with battery packs.  Over these helmets they have what appear to be space suits.  They really look like the scary government guys from the movie “ET.”  Hilarious.  Apparently these draw the air up and into the ceiling or something.  I never did figure out what that was.  There is a giant apparatus attached to the ceiling, to which they have taped plastic sheeting in front of the patient’s face.  Only the anesthesiologist, who is not in the sterile field, can see the patient’s face.

This first case is a bilateral total hip replacement.  As I arrived, they had just finished this man’s right hip.  They are ready to start the left hip now, and I have arrived just in time.  I’m told to stand where I can see what’s going on (which is still about 6 feet away), and this is pretty much where I stand for the rest of the morning.  They have a giant flat-screen TV, which is showing a close-up camera view of the operation.  I sneak a few peeks at this from time to time, but it’s much more interesting to look at the surgical field.  There is an iPod hooked up to a miniature speaker system sitting on the floor to the side, and this is pumping out some tunes at a reasonable volume.

So, onto the first surgery I witnessed.

As I mentioned, this is the left hip replacement.  The patient is a man in his 40s, and has severe degenerative joint disease, which has rendered both his hips in pretty crappy shape.  This patient has a spinal epidural in place, and is under only conscious sedation — Versed and Demerol.  So the anesthesiologist talks to him from time to time, and the patient answers back.  Amazing.

At this point they’re ready to get going.  The chief resident and the RNFA seem to be doing most of the prepping — they have shaved this patient’s left hip and leg down to just below the knee.  Then the circulating nurse applies liberal amounts of betadine to the patient’s leg.  Then the Chief and RNFA wrap the hip and leg in some sort of yellow material from 3M.  I think they call it Ioban.  It wraps skin-tight and stays on throughout the surgery.  They actually just cut right through this material when they make their incisions.  The chief asks for the scalpel, and starts his incision, which runs about 8 inches down the outside of the left leg.  As for the surgery and operating room … some observations:

  • There is a giant drape/blanket sitting on the floor in front of me (between me and the operating table).  The chief and RNFA, who is in charge of soaking up the blood with sterile sponges, throw their trash onto this blanket.  Sometimes when this trash lands on the drape, it splashes onto my lower legs a bit.  I don’t mind this.
  • At the beginning of the surgery, the scrub nurse and circulating nurse write down everything they are using for this surgery (25 sponges, 2 scalpels, etc.).  At the end of the surgery, these nurses go over this list again, and ensure everything that went into the patient has also come out of the patient.
  • The circulating nurse does a lot of paperwork during the surgery.  Every now and then she is asked to get something from the surrounding cabinets or outside the OR, and she gets this, opens up the package very carefully, and extends her arm into the sterile field, where the scrub nurse grabs it from the package.  The circulating nurse also calls over to the PACU to let them know the patient is almost ready after surgery.
  • After prepping the patient for surgery, the 1 scrub nurse, the chief resident, and the RNFA all go out to scrub in for surgery.  The other scrub nurse remains behind to continue prepping the room, and when the other 3 come in, she and the circulating nurse help them get their gowns and gloves on.  It’s really a well-oiled machine and team.
  • The anesthesiologist has an interesting role.  A lot of the time during the surgery he is just sitting there looking bored.  Other times he is hanging some blood on the IV pole or monitoring other numbers.  During the entire surgery, he is often chatting with the other members of the team.
  • Speaking of chatting, there is rarely any silence.  They talk often and loudly, about many topics including vacation spots, the Phillies, and dinner plans.  I’m sure they’re concentrating, but you couldn’t tell from the mood in the room.
  • The chief resident starts the surgery, and opens up the patient and does most of the work.  Then, in the middle of the surgery, the attending surgeon walks in, takes over, does the actual implanting of the titanium hip the patient will receive, and then walks out again.  The attending surgeon is there for, at most, 15 minutes.  The surgery lasts about 75 minutes in total.
  • During the surgery, lots of random people (all wearing scrubs, of course) walk in and out of the OR.  Some of them start talking to the operating members, and some of them just watch for a while, and then leave.  Apparently these are other nurses from other ORs who just feel like visiting.  I didn’t know this happened during surgeries.
  • The attending surgeon and the chief resident are both triple gloved.
  • It is astounding how much the surgeons manhandle the patient.  After the hip is implanted, the RNFA and attending take this patient’s leg and turn it every which way, sometimes appearing to discolate his hip.  They are doing this to ensure he will have proper range of motion, as well as to ensure he won’t dislocate his hip when he walks on it.  However, they aren’t exactly gentle when they do this.
  • Once the thighbone is exposed, the chief and attending break out the big tools.  They have to attach the new hip to the hip and thighbone, so they basically just take out this giant chisel and hammer, and WHACK WHACK WHACK WHACK away at the bone.  It seems almost barbaric, but I suppose there really isn’t any other way to do it.  Then they take out this extremely loud bone saw and just saw away at precisely measured places of bone.
  • The smell of burning bone is one I will never forget.  When the chief is burning some of the areas, and chiseling away at the femur, there is that distinct smell that I can still remember.
  • Even standing about 6 feet away, the chiseling of the bone makes some blood and bone marrow spray on my glasses.  But only a little bit.  The chief and RNFA have liberal amounts of it on their face shields.  From time to time they take a sterile towel and wipe it off, like surgical windshield wipers.

Some other thoughts about my experience:

  • Some other nurses and HCPs talk about something called “Imposter Syndrome.”  This is especially true in my OR observation.  How is it that I, a little old nursing student in my 2nd month, am allowed to just wander in and out of rooms where they are performing major operations on people a few feet away?  It’s crazy!  Such trust!  It’s amazing to me that I’m still allowed to do these things and be given access to these ridiculously cool scenarios.
  • Orthopedic surgeries are super bloody.  The patient has given 2 units of his own blood to use during surgery.  Cutting into bone is very messy.  Lots of blood and marrow and other gunk.  Because of this, the blanket in front of me is filled with bloody sponges by the time the surgery is done.
  • After the total hip, I get to stay for a 2nd operation, which turns out to be a total knee replacement.  This is less bloody because they use a tourniquet on the patient.  However, it’s infinitely cooler, as I get to see the entire knee exposed 4 feet in front of me (I lean in a little closer by this point).  All the tendons and ligaments they talk about on TV — all right there.  Incredible.
  • Patients fart a lot during surgery.  At least my 2 patients sure do.
  • After the range of motion is confirmed and the titanium hip implant is secured, the chief and RNFA measure the length of each of the patient’s legs.  I can imagine it would be a bad thing if the patient’s legs were two different lengths, right?

The soundtrack for the surgery (iPod edition) includes:

  1. The Killers:  Somebody Told Me
  2. Matchbox 20:  3AM
  3. Nickelback:  Rockstar
  4. Maroon 5:  This Love
  5. Modest Mouse:  Float On
  6. 5 For Fighting:  Superman
  7. Radiohead:  Karma Police
  8. Weezer:  Beverly Hills
  9. Sublime:  What I Got
  10. Third Eye Blind:  Jumper

I wonder who gets to pick the songs.

After seeing the total knee, it’s time for me to leave.  I go back through the doors into the lounge, where I see … 25 people eating lunch.  There are pizza boxes everywhere, and people are digging in for the lunchie munchies.  I change back into my regular scrubs, return the purple scrubs to the charge nurse, and leave the hospital.  My back hurts from standing.  My feet hurt from standing.  But my mind is spinning with intrigue.  I love the OR.

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This afternoon was my day of the semester to go into the OR and observe.  Here’s what happened:

  • 12:40PM:  Show up at the hospital and take the elevator to the OR floor.
  • 12:42PM:  Introduce myself to the charge nurse, who hands me a pair of purple OR scrubs with a nonchalant, “Hmmm, I’m really sorry, but we don’t have any surgeries really going on this afternoon, but I’ll see what’s cooking.”
  • 12:43PM:  Walk into the locker room and change into my nifty purple scrubs, wondering what I am doing here if there aren’t any surgeries to observe.
  • 12:44PM:  Scrub top:  XXL.  Scrub pants:  XXXL.  Maybe when I introduced myself, I said, “Hello, I am Ken, and I am a giant bottlenose dolphin.”
  • 12:50PM:  Charge nurse takes me to the post-anesthesia care unit (PACU) and says, “Maybe today we’ll do things a bit backwards during your observation.”  I take this to mean I’ll actually start my observation in the PACU and then move over to the OR once a procedure is ready to start.
  • 12:52PM:  Stand by one of the patients in the PACU, who’s just now coming out of anesthesia.  He’s super groggy but can tell us whether he’s having any pain.  No pain.  Good sign.
  • 12:55PM:  Still standing around staring blankly at the monitors above GroggyGuy’s bed.
  • 1:08PM:  Wondering if any surgeries will magically appear.
  • 1:09PM:  Instead of a surgery magically appearing, it’s a Circulating Nurse magically appearing to answer our questions.
  • 1:30PM:  Another Circulating Nurse takes us (another student is assigned the same shift as I am) on the Grand Tour de OR — we enter every OR suite and she shows us all the equipment.  There is a boatload of stuff in there, as well as sitting in the halls and other various nooks and crannies.
  • 1:48PM:  We pass an OR suite with a surgery going on!  What?!  I thought there weren’t any!  Maybe this one started prior to our arrival.
  • 2:40PM:  Tour is over — actually very cool.  Saw the ICU as well, which has these amazing windows where the patient can have instant privacy with the flick of a switch.  When the nurse demonstrated this, I said, “Wow, that’s like alien technology or something!”
  • 2:40PM:  Circulating Nurse Tour Guide doesn’t think I’m funny.
  • 3:00PM:  Arrive back in the PACU and sit down some more.
  • 3:03PM:  Mmm … Skittles and M&Ms.
  • 3:04PM:  Wonder whether I’m supposed to be eating candy in the PACU.
  • 3:06PM:  Am allowed to pick the music playing in the PACU — I choose “Somebody to Love” by Queen.
  • 3:07PM:  Patient B says, “I think I’m about to throw up.”  I guess she doesn’t like my choice in tunes.
  • 3:15PM:  Another nurse mentions in passing, “They have something brewing in the ER … looks like a subarachnoid hemorrhage … could be coming up here soon.”
  • 3:16PM:  The other student and I perk up a bit, thinking we might be in luck.  Brain surgery, nonetheless!  Could we be so fortunate?
  • 4:00PM:  Still waiting.  Current musical selection?  “Jukebox Hero” by Foreigner.
  • 4:25PM:  I kinda like these purple scrubs.
  • 4:45PM:  One of the nurses says it’s only a 10% chance the hemorrhage case will even come upstairs, so that we should leave.
  • 4:55PM:  Turn in my scrubs to the charge nurse (bye-bye, purple scrubs!) and head out the door of the hospital.

When I got home I e-mailed our course director to see whether she can reschedule me for another day … maybe at one of the other OR centers would be nice, since they have surgeries going ’round the clock.  I’m very interested in the OR, so hopefully it’ll work out.

As an aside, The 2-Year Penis Count has officially reached … 3.

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