I have never heard another story of a birth that was so well
planned. Thursday, July 25, 2013; it was set more than a week out. Sure, we
knew that any 2am contractions would supplant the plan, but since we’d never
experienced that kind of delivery in two previous births, it felt unlikely.
“Planning” is apparently a habit that that Mommy intends on passing along to
her children from the earliest age. Also, we had thought for months that it
would have been fun to be in the hospital at the same time as our friends the
Becklers and their first baby boy. It didn’t end up working out exactly but I
suppose there will be many more opportunities for the two boys to build some
stories later on.
We’ve been expecting Ethan since November, more specifically
we found out week we moved into our new house. The debacles of that week were
worthy of a case-study in Murphy’s law; add to it the discovery that Ethan was
on his way and you have the script for a comedy sitcom pilot.
With the new house, making room for Ethan
seemed rather straightforward since the whole purpose was to have more space
for our growing family. What followed was a series of unending projects, some
intentional and others unexpected, culminating in a new roof and a carpet
installation just days before baby’s delivery. The strangest part is that none
of these projects ended up with a completed nursery. That’d be humorous if it
weren’t so pathetic - and yet I know we’ll be laughing about it soon. I am
grateful for the power of God’s peace since we’ve experienced a growing strength
in our marriage and our family during a time that could have been damagingly
stressful.
So Ethan’s arrival had been set for a few days and everyone was
getting ready. Amanda scheduled one last doctor’s visit on a Tuesday, MM made
arrangements in her responsibilities to come Wednesday and stay a while, and I
had been weening my work schedule. The hospital was set to call as early as
5:30am to let us know that a room was ready. Amanda is already a light sleeper
so the added anticipation of an early call on top of an imminent newborn made
finding sleep nearly impossible. Sure enough, the call came on-time and she was
at the ready to answer. We were set to report at 7am to begin induction. Ethan
was just over 39 weeks gestation, well beyond full-term and a week longer than
his older siblings, so we were all ready to meet him. We left with plenty of
time to reach the hospital and nearly an hour before the morning rush-hour
started to kick-in, but were still rushed due to an unexpected delay - blamed
soley on Daddy. Given the trend of the last two, we’d be breaking tradition
without a last-minute trip to the hardware store, which I thought that I had
fulfilled the night before. This time, unfortunately, I had forgotten my
laptop’s power cable at a remote office, which is “kinda” on the way to the
hospital. The laptop would be otherwise unnecessary but has been helpful to
upload photos and to type this story. So, with shame, I drove to the office and
walked past a coworker, who (knowing full well what was going on) waved to my
wife in the car and shooed me along lest I cause any more delays. Traffic was
light and we arrived in time.
Amanda is kind of a pro at checking into Northside’s front
desk for an induction. I held back and twiddled my thumbs while she took care
of the details. There was one other couple checking in, she held herself over
the chair as a contraction passed by, and we both wondered what that’d be like
without envying them. We always have the same thought in that waiting room: you
never seem to see the dramatized television version of the moaning wife and her
confounded husband trailed by 5 friends/coworkers. That’d be funny. We didn’t wait
long so maybe we just missed it.
The delivery room was nice. By most details it was the same
as both other delivery rooms that we had seen with the exception that this one
had a real window. I could see trees! I might’ve been too excited about this.
However, I’m also glad that we didn’t have to stay long because the “husband’s
area” (despite it’s lovely view) was set out of sight from Amanda’s bed and I’m
partial to wanting to look at my wife.
Even though so many things were similar, there was enough
that was unique. The biggest change is that there was no concern with Amanda’s
blood pressure and/or preeclampsia. These had been cause for induction with
Claire and James, but Amanda watched her blood pressure carefully for the past
several months and there was never any definitive or consistent elevation;
perhaps a sign that her body was accommodating pregnancies since they were now
too familiar. Karen was our nurse that morning and since we arrived shortly
after shift change, we were looking forward to having her throughout the whole
day. In no time, we also saw Laurie, Amanda's midwife. Laurie also brought a student along who would get to help. Everyone
was genuinely excited - I wonder what it’s like to work in a place like this
every day.
We were in the room by 7:30, settled by 8:00, paperwork done
by 8:30, and the first round of induction/antibiotic drugs installed by 9:00.
Questions about an epidural had been settled and one would be ordered when the
time felt right. I was particularly concerned over this issue since the
epidural for James’ delivery had been late… Amanda essentially delivered him
without anesthesia. Amanda had even come to terms with this and wondered
whether she shouldn’t forego the procedure. Just two nights before, she told me
with a straight face that she wasn’t really worried about the pain… (um, wow. I
kinda feel like a wuss right now). Thankfully, the
anesthesiologist arrived when beckoned; she was finished at 11:15 and we
settled down to wait… which we never got to do.
After 15 minutes, Amanda felt that the contractions were
surprisingly clear. This was a little unsettling since I clearly remember a
time during Claire’s birth where we watched the contractions on the screen and
Amanda lucidly said “wooo!” I summoned Karen who came in to give a little
“boost” but suggested that we could call the anesthesiologist if it didn’t get
better. It didn’t. Actually, Amanda had a clear description
that Ethan felt “low” and that she felt like pushing. I summoned Karen again and Laurie was brought
in to confirm that not only was he “low” but he was ready to come out right
away. My thought: everyone is remarkably calm about this. My mind was flashing
back to the story of my own birth where Bama quotes the doctor saying “ladies,
I hope you’re ready because this birth is imminent; gloves please!” but it
wasn’t really like that. Laurie and her student and Karen and a bunch of other
people (who all just appeared) began the transformation of Amanda’s bed and the
room into a super high-tech delivery station, doing so with poise and grace.
12:20pm. Three pushes. I’m pretty sure that’s all it took.
Quite honestly, he didn’t need much help at all. He was laid right away on
Amanda’s belly and cried a weak little cry as they cleaned him off. The
transformation from purple to pink began rapidly and I was offered the scissors
to cut the cord, which I did with far more confidence the third time than the
first. He was wrapped up and she held him closer for only a little bit before
it was time to head into the warming station. I kissed Amanda and reminded her
of how proud and impressed I was with her strength. What a performance! I
followed Ethan to the warming station and took a few photos but mostly held his
hand as they evaluated his condition. He turned pink very quickly and didn’t
much want to cry but rather wanted to cuddle himself close and relax. He
gripped my finger with surprising strength.
“He’s retracting” This word, “retracting”, they kept repeating it over and
over. I didn’t really understand what it meant. He looked fine. Sure, he was
breathing kinda fast and hard, but they all did after being traumatized by
being born. They told me it might still be some fluid in the lungs that he had
taken in or not quite evacuated. They rubbed him to cry and he did, a little. I
rubbed him to cry and he just calmed down.
They called in the “transition nurses” to evaluate him; in a minute two
more nurses with a bright orange bag arrived and began saying the same things.
Amanda saw all of this going on from across the room and didn’t really
understand what was happening. In a short bit, Ethan seemed to be doing better
so the transition nurses left. He was wrapped up and given to his mother to
hold more closely. I would later show photos of this moment to Claire and try
to explain that Mommy loves her children so much that it makes her cry tears of
joy; that her love is so big that she can’t hold it in and it comes out her
eyes. Ethan opened his eyes for the first time and looked right at Mommy. He
tracked back and forth carefully, looking all around. He was calm and comfy and
at home.
We still hadn’t gotten a few more measurements like weight
and length. The nurse brought Ethan back to the warming bed and again noticed
the “retracting”. He was also “grunting” which sounded more like a sad sick
moan during the exhale. I think I refused to acknowledge that anything could be
wrong because I could not see the same things that they were seeing – thank
goodness for their expertise. While we waited for the second team of
“transition nurses” Ethan was weighed (7lbs 3 oz) and measured (20.5” long) and
all the while I agitated his feet and back trying desparately to get him to cry
and spit out this “fluid” that they were telling me about. He just didn’t want
to cry very much. The transition nurses arrived again with their bright orange
bag. After evaluation, they determined that it would be best for Ethan to go to
the “Transition Nursery” to be monitored as he processed the fluid still in his
lungs (Transient Tachyphnea). He was wrapped again and brought to Amanda for a
nursing attempt before he left. It was a little much to expect him to latch
when all he wanted to do was relax and breathe. He simply stared at her and
slowly blinked.
I was nervous. I placed Ethan into an incubator crib and
followed him to the Transition Nursery. I wasn’t sure how nervous I was
supposed to be because I was reassured that this condition was quite normal and
many babies get over it within a few hours. I was also told that he wouldn’t be
in the Transition Nursery for longer than 6 hours. I would have been more
nervous if they had told me that after 6 hours he would be admitted to the Special
Care Nursery. Apparently they know about this since I later figured out that
the message is deliberately designed to keep me from getting too worried…
“Special Care Nursery” is a replacement word for NICU.
Ethan joined five other babies in the Transition Nursery,
four of them retracting and grunting along with him. Under a warm lamp the
nurses measured his vitals. He still didn’t want to cry but recoiled and let
out a pretty good wail when they gave him a shot. He delayed for a moment when
they stuck him a second time to measure his blood sugar, but delivered another
good wail after that. The first problem requiring attention was low blood sugar
(36 out of a 40-200 range) remedied with a snack of formula. Amanda and I are
pretty big fans of nursing and neither Claire nor James had ever been fed
formula, so this was a little difficult for me to get over at first, but I
wasn’t going to object to Ethan’s immediate needs. He gulped at the bottle and
even burped with just a little patting. I stayed and stared and held his hand
for a little while longer then left to go help Amanda move to the recovery
room, explaining the whole scene to her with a positive attitude that he would
be back soon.
Thus began the first series of back and forth. I moved
between Ethan and Amanda, gathering as much information about his condition as
possible and relaying it back, and trying to figure out when she could come
down herself. The doctor was called, xrays were taken, blood was sampled, and
with each passing hour it looked like Claire and James would not have time to
visit Mommy and Ethan before bedtime. They had been making cupcakes for his
birthday, I’m sure they were also disappointed that they would have to wait to
eat them.
A chance to hold him was apparently rare and special. I
cuddled him for nearly an hour and he “grunted” the whole time. Try as I might
to help him enjoy it as much as I did, the most comfortable place for him was
back in the crib. Before leaving again, I had quite a few questions and thought
of so many more later on. Things move both quickly and slowly. When Ethan is
busy, it seems like something is always right around the corner, plus there’s
always “one more”, which means something else is delayed – like eating. I had
been calculating to a nurse that if we waited on too many procedures, than it
would be not 3, not 4, but nearly 5 hours between meals. I returned to find
that he had received a tube through his nose to his stomach; something which I
had winced at when described but didn’t seem so bad now. At least he was
getting fed at the right time.
Bonus dinner (for Daddy). Food services brought an extra
meal to Amanda, so I ended up with some free meatloaf.
Back in the transition nursery, the 6-hour limit was fast
approaching. I waited for the neonatal physician for quite a while as she made
her rounds down the line. She was quite thorough, and I was the only parent in
the room, so this was a tense wait. When she got to Ethan, I was grateful for
her thoroughness. The diagnosis was
rather simple; his “transient tachyphnea” hadn’t cleared simply because it
takes longer for some than for others. “How long” is the obvious next question
and despite asking in every way possible manner I received no clearer answer
than “it depends”. I’m not a stranger to this kind of response, but it felt
like there had to be other clues that could give me a sign of what to look for.
I relented from further questions and asked when Amanda could come see
him. To this the doctor absolutely agreed and I intentionally did not mention
comments nurses had made that it was a little too crowded. Now 6 hours, it felt
too long for Amanda to be away. I went upstairs and briefed Amanda, breaking
the news that Ethan would not be joining us but would be moved to the special
care nursery overnight. We asked for a wheelchair and I wheeled her down. As I
introduced her to the space and continued to explain all that I had learned, I
realized that this was the first true time that I had more information about
our child’s health than she, and that this would be my key role for the next
few days.
We stood over Ethan, with his chest pumping rapidly and weak
moaning, holding his hand and holding back tears. Nurse Jaqueline stood with us
and answered our long list of questions, including how we would be able to get
Amanda’s milk to Ethan’s feeding supply. Jaqueline was the first person to
admit that the “special care nursery” is really the new name for NICU, and I
was grateful that she said it.
That evening and throughout the night I went to visit Ethan
for each of his feedings. He was covered in sensors, bandaged at the foot from
blood samples, stuck in the hand to receive antibiotics, and still had the
feeding tube through his nose which was now crowded by an air and oxygen tube. That
night, the nurse saved for me the changing of the dirty diapers (Amanda claims
she’s never changed a diaper in the hospital, and I agree that I’ve changed
quite a few now). I held him throughout at least one feeding; we locked eyes
and he traced me back and forth, he was calm, and did not grunt or moan, so we
enjoyed that moment. Amanda joined me for an early morning visit and held him
through his feeding but he moaned as he exhaled then quieted when laid in bed.
Being apart was hard, but harder still was the notion that he was less
comfortable in our arms than in his hospital bed. He was laid in his bed on one
side, then another, and then on his tummy, all in an effort to find the least
objectionable position for him to rest and get well.
MM and Pops brought Claire and James to visit Amanda in the
hospital. Claire asked several times where Ethan was and wanted very much to go
see him. Amanda tried to explain why we couldn’t but stopped short and changed the subject, holding back tears
so that Claire would not see. They played on Mommy’s bed, we ate lunch, and
they sang “Happy Birthday” to a video camera while they held cupcakes that they
had made for Ethan. I wanted to show them what a birthday was all about and I
think Claire made the connection, even if Ethan wasn’t there to say thank you.
Earlier that morning, Amanda and I were conveniently were
present for the visit from the pediatrician. For this chance and the ones that
followed I am also grateful. Despite not knowing when the pediatrician(s) would
visit, Amanda and I were each waiting at Ethan’s bedside when they arrived.
Also, even though he was seen by the neonatal physician just once a day, and
again we would not know when this was, I was still with him each time. Throughout
Ethan’s stay there were a lot of changes and decisions, yet we were always
there when it was happening. Friday afternoon was particularly important. The
physician noticed that a morning xray was clear of the fluid that had been the
initial cause of his admittance, yet Ethan’s breathing was no better for it.
This suggested that something else was wrong and the physician explained not
only each of the possibilities, but their respective treatments and exactly why
another xray would be necessary (I’m not a fan of imaging without a clear purpose
or a reasonable alternative, so I was pleased to have a thorough justification).
It’s either a lack of surfactant to absorb oxygen or an air sac caused by a
hole in the lung, or both; give it a name such as “Infant Respiratory Distress
Syndrome” or “Pneumothorax” and it sounds much worse than the layman’s
description. Xray #1: yes the first, maybe also the second. Xray #2 (turn him
on his side): yes the first, nope on the second… just “pneumomediastinum”,
which sounds even worse since it has more syllables but the doctor explained
how this was fine (comparatively). Now we can start the treatment. I should
mention at this point that: 1) Ethan had been a champion throughout this
process but was likely due to his weakened state, had he been healthier he likely
would have fussed; and, 2) this all took over two hours and I had already been
there for two more, so I’d been interjecting the whole time that I would like
to go get my wife but there was always “one more thing just around the corner”
that they wanted me to wait for. I couldn’t step out to call Amanda because I
didn’t want to miss anything, and I couldn’t text her because that was
insufficient… and yet I never thought to call her on the landline at the
nurses’ desk. How could I miss that? That’s how she called me. I tried to
explain everything that had happened and apologized for the troubles with going
to get her, it felt right that I should stay but wrong that she should be
missing this. As I talked, I held back tears watching the nurses install a new
air supply system; Ethan’s oxygen level
dropped when they removed the first mask so one nurse worked a manual breathing
mask over his face. The additional tubes and machines created a weight in my
heart, forcing me to concede that Amanda would be leaving her hospital bed long
before Ethan left his. I retrieved her to come see what had happened and we
were turned away by the receptionist for an hour while he received a sterile IV
unit. “An Hour!?” Amanda saw my reaction before I was able to unleash it and
calmed me down, doing so in spite her own frustration. We retreated, ate a
tasteless supper, and returned to his bedside.
We needed better rest than one could get in the upright
chairs of the NICU. There were a few gliders available, but it was a bulky
thing and got in the way of the nurses who checked on babies frequently. The
cramped sensation of the NICU was quite different from the spacious
accommodations in the birthing and recovery rooms. Certainly it was designed
for the benefit of having babies conveniently close by to the staff, but it
made “hanging out” terribly uncomfortable. I wasn’t willing to admit it at the
time but that is actually a windfall of the arrangement – parents are so
restless in the NICU that they sleep and relax elsewhere. And so, as everyone
else did, we retired alone to the recovery room for a second night. I
successfully awoke once in the middle to witness his feeding and do what little
I can to change his diaper. Several wires and tubes were routed through the leg
of this diaper and in my drowsy state I stumbled to return them to an orderly
fashion. Thankfully, Ethan appeared to be an easy-going guy so far so he didn’t
bother to criticize the tangle I made.
On Saturday morning we found that our little guy had earned
himself a larger set of air hoses up his nose. Rather than the thin set of
flexible tubing, these were wider corrugated plastic things that allowed a
lower air pressure and better humidifcation. It was padded to each side of his
head and strapped on along with a hat to hold it all in place; looking not
unlike an old kicker’s football helmet with a single-bar facemask. These kind
of adjustments were frequent, a sign that the doctors and nurses were paying
attention to his needs and applying the best available solution to make him
well. But it was also a sign that he wasn’t getting better nearly as quickly as
we wanted. We had been told that Monday was a day to look forward to, a rare
estimate since a majority of staff was reluctant to give any kind of timeframe.
But this was Saturday, the day we’d be taking him home if things had gone as we
had initially expected.
As we began sending out photos, texts, and emails, messages
from family and friends poured in. Aunt Dana was an excellent source of
comfort. Cousin John had been born premature in December of 2012 and spent
seven weeks in the NICU before being released. During that time he outgrew
every other baby in the room and saw several come and go. It was a frustrating
process to check off the long list of “milestones” that were needed before
being cleared to leave; the poor little guy just couldn’t get a break. Ethan
wasn’t nearly in the same situation since he was much bigger than the other
babies in the NICU the moment he arrived. However, there were similar
experiences that benefit from the counsel of someone who has been there before.
MM brought Claire and James to visit for lunch. Though the
siblings were far too young to enter the room and see Ethan, they fawned over
the new photos of him. MM cuddled him for her first time and the tears of joy
that she had shed for Claire and James in those experiences returned easily. Lunch
in the cafeteria was a testament to just how restless Claire and James had
become. Clearly they were tired and needed Mommy to come home, so it was
decided that MM would take them to her house. They love MM’s house. They love
playing with Pops and Uncle Logan. And it is understandably easier for MM to
manage the two bundles of pure energy on her own turf. I left Amanda with Ethan
and went home to help MM pack.
One of the most difficult issues for Amanda to deal with was
the inability to nurse Ethan during his first days. This task was one of her
favorites and is also a gift since, as we know, it is not a guarantee. The
alternative during this time was pump as much as possible to fully supplant the
formula that he was receiving. It would be stored in a refrigerator, prepared
daily by the staff, and delivered through Ethan’s feeding tube at his meals.
Though, since he was already eating several ounces it became a race for her to
catch up to his growing appetite.
Our time in the recovery room was coming to a close by
Saturday but we were told that there was the possibility of reserving a room
for a night. They call this bonus night “nesting”. This possibility was based
on several contingencies, primarily the availability of space. Things always
look busy so there’s no way to tell, but near midday we were grateful to hear
that Amanda would be allowed to stay in her room until the next morning. They
even arranged it so that she could get an extra supper. No breakfast though,
and no visits during the night to see how she was doing. It really felt like we
were stowing away in plain sight since everything kept on moving around us but
we were no longer a part of the routine of that floor.
We had a special Skype with James and Claire after
suppertime and it seemed like they were quite content to have MM take care of
them. Getting them fed and dressed for bed can be tough but she didn’t miss a
beat. That night, when I went down in the middle of the night for one of
Ethan’s feedings, his nurse gave me a package of gifts for Claire and James to
play with that included infant diapers, boots, hats, and special gooey stickers
that they use for the breathing sensors.
Sunday morning was tough. We were out of our spare room by
8am and traveled downstairs to sit with our sleepy Ethan. But the space near
his bed was miniscule, uncomfortable, and probably intentionally designed that
way so as to encourage parents to feel free to leave… which was something we
had never imagined doing before. We left for home, if only temporarily, without
Ethan and there were soft tears shed for his absence. Claire and James were
excited to have the gifts from the nurse but far more excited for their
adventure to MM and Pop’s house. We helped MM on her way and said goodbye then
found ourselves in a house that was much too silent. When we returned after
lunch, we found that Ethan had been upgraded to a smaller breathing tube in his
nose. He also was wearing a special gift hat that had been knitted for him by a
service group of generous women whose mission it is to bless families with
children in the NICU. We multiplied these upgrades by dressing him in his own
clothes that we brought from home and pictures drawn by James and Claire before
they had left. Along with their gifts, Ethan’s nurse had invited them to add
their own drawings and suggested high contrast colors of black and red on
white. These drawings included adorable messages and LOTs of hearts. The final
touch was a small tiger cub perched on the corner of his bassinet to keep
watch.
If Sunday morning was tough, Sunday night was gut wrenching.
There was no place for us to stay at the hospital and although we were always
welcome to visit in the NICU the available seating near Ethan’s bedside was so
small that I’m pretty sure they never considered anyone actually spending the
night there. There was rest to be had, but it took a long wait to reach it.
Monday. This was the day I was waiting for. When he was
first admitted to the NICU I pressed constantly for an estimated time frame and
finally was told that the average was about four days. This meant Monday would
be the day and it didn’t appear that things were going to be quite as average
as I wanted. There were still several milestones to hit and Ethan wasn’t
getting any of them. Except he didn’t appear to be in any different state than
he was on Sunday; …which wasn’t really too different itself from Saturday. So
the waiting continued. We spent the morning and evening at the hospital,
sitting and holding and reading and eating. Amanda became acquainted with a
special room made for nursing in which she could pump and more directly supply
Ethan’s food to the refrigerator.
Tuesday is what I repeatedly called our “Quadruple Bonus
Day”. Rather than earning his milestones one-by-one, Ethan decided to hit them
all at once and met all the diagnostic criteria to move off of the air supply.
His stomach clearly agreed with this decision because he took a whole bottle
down without any hesitations or hiccups. For this effort, he was awarded a
regular bassinet just like we were used to in the recovery rooms and even but
on the list in the NICU recover section. That same day, our friends the
Becklers arrived at the same hospital to delivery their baby: “Nathan Marc
Beckler”. Although we had never discussed it with them, Amanda and I had been
thinking of the name “Nathan” as a backup just in case we decided at the last
second that the name “Ethan” wasn’t what we wanted.
It wasn’t until Wednesday that Ethan was moved to the
upstairs recovery section of the NICU. It was a beautiful space on the top
floor lit with skylights from the ceiling and sectioned off into isolated
hallways that each held a few “nooks” for each family. Inside each spacious
nook was a comfortable chair and cabinet with plenty of space for changing
baby. There were special well-designed changing stations and baths in each
hallway. Despite the number of tiny children on that floor with not a single
wall that reached the tall ceiling, it was surprisingly peaceful. Ethan was
only here for observation and had shed every last monitor that was attached to
his body. Despite this, they were still not ready to release him and required
that he stay one last night. Perhaps if MM had actually stayed at our house
with James and Claire we would have felt more stressed for Ethan to come home
sooner but we were probably able to accept this decision since both home and
this new space were, at present, peaceful. That evening, we were grateful to
attend a pizza supper hosted by the Special Care Nursery Outreach and Support
Services for parents with newborns in NICU care. We met just a few parents like
ourselves, with a child in special care for a few days; but we met several more
parents whose children were born premature and had been under care for several
weeks. I’m not sure I’ve ever been witness to a support group, but this
gathering seemed to have many of the same goals and it appeared that those
parents who had been there for far too long were immensely blessed by these
forums to socialize with their neighbors.
Oh what a happy day Thursday was. We were told on Wednesday that Ethan
would probably get to come home on Thursday so we arrived that morning
practically floating as we anticipated bringing him back with us. It took a
while to complete all of the paperwork and wait on the pediatrician for one
last inspection, so Ethan received an extra bath and practiced nursing during
his last few hours in the recovery center. By lunchtime we were ready to depart
and despite the delay, Amanda still got to ride from the top floor to the front
door in a wheelchair while holding our newest joy. Just as before, his first
car ride was careful and slow. This was the first time welcoming a baby to our
new home though Claire and James were still with MM so the house was nearly
silent as we crossed the threshold. That didn’t last too long. MM arrived later
that day with the two older siblings who were all too excited to see Ethan for
the first time. They squealed with delight. They whined a little. They petted
him and snuggled him. They welcomed him into our family and it’s been a
wonderfully exciting experience ever since to witness the three of them
together.
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