Shrink's Views

ramblings of an unknown psychiatrist

Archive for the ‘law’ Category

Rights and Love: a story

Posted by Dheeraj Kattula on September 7, 2010

He was a tall man. Dark and young, his name was James. He came for a full cup Chai* five years ago. He never stopped coming. To him, Chai was like petrol. It kept his engine running. He made friends easily. He became friends with Rafique on the very first day. Rafique was here to buy his bundle of beedis. The minute James realized that Rafique has just discontinued studies; he spent an hour with him to get him back to school. He failed. Of course! Who can convince a thug in the making. I have been hearing Rafique’s mother Salma begging him to study properly for the past 10 years now. It was of no avail. Rafique played the fool throughout his school life. He was no different from most of the guys in Dharavi. Honestly, at his age I was like that too. I left my home in Allepy when I was younger than Rafique. My original name is Abdullah. People now call me Nair. When I came to Mumbai, I wanted to be a hero, a star.  Fate had its way. I became a chaiwala*. I work hard and earn my roti*. That is a decent life. Isn’t it? At least I did not do crime.

Even though Rafique did not take advice, he realized that James was his well wisher. He became his friend and partner in his work. James was like a student who was interested in finding out our problems. He wanted to know about our lives. He wanted to find how we decided what was right and what was wrong. He wanted to know what we did when we perceived injustice. Rafique helped him meet up people in the slum. James came twice a week and did his job. He never missed his full cup special chai in my shop.

In about a year, James started educating us about our rights. He told us about how the real system ought to work. We knew how it worked. The constable on beat was the symbol of all authority to us. Give him a free cup of chai, he would not bother you for the day. The other symbol of power we know is the neta*. His ilk come here before the elections and would never show up again. The bigger guys here keep in touch with the netas. James taught us that these fellows are there to serve us and not get served by us. He also told us about the court system. In fact, that year Police picked Zuber and locked him up. They had suspected him in some bomb-blast case. We knew Zuber as a hard working tailor. He was cool and liberal. He could have no such links. James came to our rescue. It was then that we came to know that he was a lawyer. It seems he had studied in one of the best law colleges in India. I heard it is in Banglore. To us he was like God. Zuber was back. We learnt we could fight.

He fought few other court cases for our slum people. One was a divorce of Janaki and Kadam. Kadam’s drinking was routine. He beat his Janaki black and blue. One night she fell on a doorpost and bled from her scalp. It required 4 stitches to control that bleeding. Next weekday was the day James usually came to our slum. He spoke to Janaki and other neighbors and reported to the police. Police laughed at the issue. They said domestic fights between husband and wife are normal and they should be sorted at home and not police station. With James around they anyway had to register the case. James tried counseling Kadam. I would not have even tried. Some people won’t change. Atrocities on Janaki increased. Janaki decided to leave Kadam. Where would she go in Mumbai? How would she feed herself and her little five year old son Babul? She was concerned as Babul too was getting beaten regularly. She was also afraid that he could become like his father.

James fought for her and got her a divorce and also the custody of the child. Guys like Rafique too were not very happy with the divorce thing happening. Why? Aren’t other women adjusting with alcoholic men? Aren’t other women tolerating few beatings received from their husbands? James reasoned that we all have basic rights common to all mankind. One such thing is a right to life, liberty and security. He said our liberty should end one foot away from his neighbor. Here we had Kadam always violating his wife’s right to security and exercising his pseudo-liberty. He also felt Janaki could leave her husband exercising her right to liberty. I can very well understand that. Marriage should be based on mutual continual nurturing relationship. I was sort of convinced that she had a right to break the marriage. James also found Janaki a house maid’s job in Rajiv Gandhi Nagar, which is not too far from Dharavi. Kadam has died two years ago in a train traffic accident. Obviously, he should. He was totally drunk and was crossing the railway tracks. I wonder how he had survived 40 years on those tracks.

During last year’s elections most of our area’s people had gone to election campaign programs for money. There was very little business. I could have some personal time with James. I asked him about how he spent rest of the time. He said that he visited slums in Thane and Pune on a regular basis. He was doing the same thing that he has been doing to us, providing legal aid. I asked him how he managed to live. He smiled and said that few friends support him. Many of them were from a  network of Lawyers. There were others who also contributed. A dozen of them gave about Rs 1000/- each per month. That probably washed their conscience of the guilt of not doing anything for the poor. Many of those lawyers had monthly income running into Lakhs*. His wife Agnes was a teacher in a school and she earned another Rs 5000/-. They managed their livelihood in Mumbai with that money. It was difficult to imagine the kind of place that he was staying. He probably was not too better off than us.

Last year, he started coming less frequently. I was busy with pregnancy of my wife. I did not notice that I did not see him for six months. He came two weeks ago. He looked tired and worn out. His head was low as he walked past my shop.  I shouted for him, “ Saab. Chai?”  He pulled himself to the bench in my shop and sat down. I gave him his usual -special full cup Chai. He looked at me as he sipped and smiled. He looked older and mature. His dynamic force was gone. He was sober but looked to be in control. He finished his cup and went to meet others in the slum. I got busy with my work.

That evening I met Rafique. I told him that James had come that morning. I also shared my observations and expressed my wonder at the change. Rafique smiled and said, “You will never believe what he has gone through. He appears different, but this is what he really was- all the time that we saw him.” “Why? What happened? Tell me what you know”, I asked knowing very well that Rafique being close to James would know more.

Rafique narrated this story, “ Agnes, the wife of  James Sir had been suspecting him of having an affair with someone. She put strictures on where he could go, when he would be back, whom he would talk to and so on. She also felt that he was trying to kill her. Six months ago she stabbed James in his stomach with a knife. James was lucky; the knife pierced his bowels but spared his blood vessels. His neighbors heard the shriek and rescued him. They took him to Lokmanya Tilak Municipal General, Hopital in Sion. They did an operation and saved him. In the meantime his wife Agnes was arrested for attempted murder.”

“Oh! My God. It should be tough on James to go through all this”, I asked “What happened next?” Rafique said, “I am still shocked at what James has done. After his discharge, he fought for release of Agnes and won the case. He then got her treated in a psychiatric facility. They gave her shock treatment and medicines.” Rafique added, “She had not responded well to treatment. She is now on the best medicine in the world for her problem. James Sir takes her for blood tests every week. She still has not improved. She is suspicious of him even now. James Sir still lives with her, though he had to change the locality. The locals requested him to vacate. Our great lawyer chose not to fight.” I felt numbed. I could not say anything. Rafique had his cup of chai and left.

I could not sleep well that night. How can James live with his wife after what she did to him? How can he continue to be with her when she still poses a threat on his life? How can he share home with such a dangerous woman? Why can’t he divorce her and start a new life? He has helped so many people start afresh.

When he came today, I asked him, “Saab, Can I ask you something personal?” He agreed with his usual smile. “Saab, I heard what has been happening in your life from Rafique. I feel very bad about it. I want to know why you want to continue living with a person who is suspicious of you and has tried to even murder you? Can’t you choose a life of liberty that you want us to have? Why…?”

James then said, “Nair, we all have rights. Don’t you realize, if we all had our rights then nothing will be left. We all give up our rights for those we love. Don’t we? You have every right to eat from what you earn. Would you spend it eating Chicken Biryani alone or would you spend money to eat normal food with others in family? I have a right to liberty. I can divorce her as she would not allow me to be close with her, but I also have a duty to care for her. I have made a promise to be together in health and in disease, in happiness and in suffering. I will keep my promise even if it means to give up some of my freedom.

“But…You fight for our freedom”, I asked. He said, “Yes, I do fight for freedom and so many other rights. Many of our friends are unaware of their rights. If they are aware they would like to claim them. I help in raising awareness and helping fight to claim it. If someone does not want to claim a right for a different purpose, it is absolutely acceptable. It would be nice if that purpose is rational. Do you remember, last year Shinde joined BSc in Maths though he got a quota seat in Engineering. It is rare for someone to get to college level from Dharavi. Everyone scolded him. I knew he had a higher agenda. He wants to prove himself. A person who can run does not need crutches. Shinde will come up in life. He will live with self respect. Watch him. Anyway coming back to the point, rights give people a chance to make their life beautiful. Giving up your rights too can make life beautiful. In the case of me and Agnes, it is not yet beautiful. I agree I do not know what can happen to me, but that is alright. In a grand plan of people caring for their family, it is already beautiful.”

As I saw him walk away, I wondered James did give up much to be with us and has made life more beautiful for us. I found a new definition of love: That which makes the subject give up his/her rights to make life more beautiful for the object of his love.

————————————————-

*Chaiwala- One who deals with Tea.

*Roti- Pancake made from wheat. Contextual translation- bread.

*Neta– Leader, usually political.

*Lakh- 100,000.

*Saab– Sir

PS:( added on 25th September 2010) A sequel to this story “Love: Feeling, Reason and Choice” can be found here.

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Posted in distress, drug therapy, education, emotion, ethics, fiction, gender, indian society, law, love, marriage, psychiatry, schizophrenia, stigma, women's issues | Tagged: , , , , , , , , , , , , , , , | 18 Comments »

eros@ergon.con*: a conversational story

Posted by Dheeraj Kattula on July 6, 2010

Recently an Indian CEO was sacked from his company because of a complaint of sexual harassment. He maintains what they had been in a consensual, flirtatious relationship that grew out of a close friendship with a colleague. This story triggered me to think on these issues.

Here is a fictitious story in form of conversations bringing out few issues which might have relevance to sexual harassment. I am no expert in this field. Though I have heard of many stories on domestic violence I have not heard much on sexual harassment. What I know is limited to conversations I have had with friends, patients and co-passengers in trains. I call the story “eros@ergon.con”.

*******

“Have you heard of what is happening?…This is bullshit going on here in our company.”

“I know. I work in Vicky’s team. I also know the reasons for all this.”

“What exactly happened?”

“See, Rashmi joined our team six months ago.”

“Is she the one we saw in the theatre last month?”

“Yes. She is the one. Remember, she was there with her boy-friend.”

“I remember being introduced to him. Ramesh is his name. He is in the accounts department…Ok. So, what did she do?”

“She has not been doing well in the job. Vikram had to admonish her for her mistakes. She felt offended. She filed a complaint of sexual harassment against Vicky.”

“Oh my goodness! I heard about that complaint but did not know the background. Anyone who knows Vicky can vouch for his integrity. It is terrible for his name to be stained like this. I wonder how he and his wife have taken this.”

“Rashmi has been roaming around with Ramesh whenever she is off duty. Their relationship is secret. Ramesh’s parents would never agree for their marriage. She is probably stressed. This gets carried to work. Instead of accepting responsibility she has used her trump card to defame Vicky.”

“Vicky’s name would clear off after the enquiries, but what about the trauma he is undergoing. She loses nothing for filing such a complaint.”

“She should be sacked for raising wrong allegation, when Vicky is cleared.”

“Some of these girls are crooked and some are just sensitive idiots. Last year, I had a complaint against me.”

“YOU!”

“Yes. It was a tough season. Our team leader Mrs Johnson wanted us to finish a job within 24 hours. She announced this at the end of the working day. It meant that I would not be going home that night. Our friend Raju was admitted in the hospital and I was to go to relieve his wife Laxmi for few hours. I was so pissed off at such untimely deadline, I pointed my middle finger as Mrs Johnson left the room. I basically meant **** off.”

“I can understand.”

“You have seen Swathi in the party two weeks ago. Didn’t you?”

“Oh! Is she the girl, who was sipping coffee when we were gulping beer in the party?”

“Yup! The very same girl. She saw my gesture. She went to Mrs Johnson and complained of this offensive gesture the next day.”

“Oh my God! What happened?”

“Mrs Johnson came and congratulated our team for staying up the whole night to finish the work. She also said that if we had not completed the job then she might have had to send us home to…as she said that she pointed her middle finger.”

“Really? She is cool.”

“We all had a good laugh.”

“Except Swathi…Perhaps.”

“We have to be sensitive to people around us. It is very true, but what if someone does not fit into our culture at all. What can we do if a person is overly sensitive? Thankfully Mrs Johnson is cool. If she was another sensitive nut, I would have had it.”

“It is a pity that Swathi could interpret a sign of frustration as a sexual gesture. But I respect her. She is good at her work and has good character. She is not like Urvashi, who sleeps with the boss to get promotions. In fact she has to do such shit to even retain her job.”

“Isn’t it interesting that everybody knows that the CEO is sleeping with a staff and nobody batters an eye lid. Urvashi’s father is a professor of Sanskrit and Indian Culture. I cannot believe how a girl like Urvashi is born into his family.”

“Who knows one fine day Urvashi might file a case in the court against the big boss for sexual harassment? Ha ha ha”

“Yes! The world would believe it to be harassment too. Poor girl…what other option does she have in this male dominated society…She had to do it…She kept it secret for long because she was stuck with fear…etc.”

“Absolutely true. These are bullshit arguments in her favour. She made her choice. She is doing this to move ahead in the corporate ladder and nothing else. If she really has some emotions for him, then she would realize with time that the CEO is just using her. Rashmi sleeping with Ramesh hurts the company in an indirect manner. It does not affect others directly. Urvashi’s sleeping with the boss is a lot different. She is growing in the ladder bypassing many worthy people. This would hurt the company more. Don’t you think so?”

“Incompetence and physical beauty put a girl at risk of being solicited for sex in her work place by people who can cover her incompetence. If she is ambitious, she uses her beauty to bait men around her to cover for her lacunae. I really do not think this kind of thing can be called sexual harassment. It is happening with the choice of the woman.”

“Whenever there is less difference between two people and the difference that a senior can make to them is huge, favours including sexual would tilt the scales. You can take the entertainment or fashion industry for example. At least this is not so much pronounced in our technological industry.

“True. In fact, the ones who can be considered as harassed because of sex like this are people like Mrs Johnson, Vikram and us. We work hard and finish our projects but we are sidelined to make way for people like Urvashi.”

“Hmmm…That is right. It is OK. In the long run we will catch up. So long as we enjoy our work and our compensation, why bother about others? Anyway, I got to go buddy. Bye for now. I will catch up with you in the mall this weekend.”

“Ok. Bye. Take care.”

************

(Inside a sub-urban train)

“Hey! What is up man? You look sad.”

“Sure. I do. I have reasons for it.”

“Want to share? You could…if you want to?”

“I got fired today.”

“Oh I see. Any reasons?”

“See, I am a laboratory technician in a college lab. I am in love with a final year student in the college. The college management feels that if they fire me they would send a strong signal to discourage romantic love inside the college.”

“Don’t mind this…Did you do something?”

“No…Nothing that you might imagine. We have not even touched each other. We know each other for the past three years. There was some Chemistry between us. We learnt more about each other over coffee. I proposed to her three months ago. She accepted. We have planned to get married after her graduation, which is two months from now…and now…I am unemployed.”

“What the hell is this? There is no complaint, no problem in your work or her studies, just arbitrary dismissal for being decently involved in love though there are marriage plans. This is surprising.”

“I am not surprised. Last month my friend gave a love letter to a colleague proposing to marry her. He got dismissed for this itself. She filed a complaint of sexual harassment.”

“Oh my God! This is ridiculous. I cannot stand this. Where do I go? Is there an escape from this kind of persecution? Looks like anyone can harass a man. A day will come when men file cases against men saying the boss is sexually harassing them. I have developed a phobia. I am going to leave working for a company. I will not start a company too, where I might have to employ people. I have to try my hand at politics. That is a safe place, where no one talks about even about the culpable ones. It is a place where the daring can brazen and the phobic can hide.”

“I don’t get you.”

“You don’t have to get me. Even I don’t get me. May be I need to consult my friends in NIMHANS $, Benguluru.”

*********

*

“Eros” in Greek means Romantic love

“Ergon” in Greek means Work

“Con” means

1. on the negative side

2. to trick; involve in abuse of confidence

$

NIMHANS- National Institute of Mental Health and Neurological Sciences ; a premier psychiatric facility in India

Posted in bussiness, distress, emotion, ethics, gender, indian society, law, love, management, social, stigma, women's issues | Tagged: , , , , , , , , , , , , , , | 5 Comments »

“There is a limit to suffering one can take. I have to poison her before she brings disgrace.”

Posted by Dheeraj Kattula on April 5, 2010

She had an innocent smile of a child on her face. It was the first time I was seeing her. She was of dusky complexion, cute looks and shy behaviour. She had been on low dose anti-psychotics for few weeks. Her mother complained of her missed periods. Every day, we reassure a lot of people regarding menstrual abnormalities secondary to anti-psychotic use. As I reassured them, I could see that her mother was not satisfied. She complained of swelling in her lower abdomen. I smiled sarcastically at her ignorance. I felt she was worried thinking of menstrual blood getting accumulated down there.

Ignorance is fought with education. A couple of minutes of psycho-education could let them cool down, I thought. As I reassured them again, I noticed a smile of the patient. It was not the usual smile. It had a touch of mental retardation. I became serious. I knew she is a likely victim of sexual abuse. She was single, female, poor, beautiful and mentally disabled. I looked at her parents again. They obviously knew better than me of the possibilities. That was why they looked so distressed. They were afraid of the worst possibility- PREGNANCY.

The elderly couple also have a son. He has chronic Schizophrenia. He is dependent on them. The patient in front of me was dependent too. The grown up children cannot do any meaningful labour in the marketplace. Their mother is the bread winner. Their father is unable to work anymore because of old age. He minds the kids at home. The old lady was already in tears. I told her that she was not alone and such suffering is not uncommon. I realize these words are empty. Suffering hurts most when it hurts you.

She wiped her tears with the free end of her saree. She said “There is a limit to suffering one can take”, as she blew her nose she added, “I will have to poison her sometime, before she brings any disgrace to us.” I could understand her pain. I was shocked to see her daughter smile innocently as she heard this. I knew why this ghastly filicide had not happened till now. It is not tough to kill someone who would submit to you with a smile. It is impossible. Her mother loved her much. She just did not know how to handle her situation,  if at all there is a right way to handle it.

I wanted to send the patient for a pregnancy test. I also wanted to treat her with dignity as an individual with some ‘capacity’. So I asked her if ‘any man had come close’ to her. She agreed with a shy smile. My heart sank. Her mother nearly fainted. She reached out to the nearest bench that was available. I told them not to worry. We could find out if she is truly pregnant in the first place. Her missed periods could be due to medicine itself.

 Her parents did not want the test!!! Why?? I was shocked. They should be asking for it not me! They told me that a test would take time and if they do not go back in time, their schizophrenic son might wander away. Our OP assistant gave them an idea. Her father could return home and mother could take the patient back after the tests are over.

After a couple of hours, I saw them again. The pregnancy test was NEGATIVE. I sighed with relief. I am pro-life. I cannot think of recommending an abortion. We don’t do it in our hospital either. In fact if she was positive, I really do not know what I would/ should have done. Thank God! The old couple would not get another dependent into their family. They also did not have to kill a weak and helpless unborn child.

I told the mother to teach her to keep a distance from unknown men. Of course I know the ones who abuse are usually the known men. But here it was the case of an unknown man. Her mother told me that she had beaten her number of times to teach her that lesson. I wondered why she had to beat her daughter before an act was done! She knows her daughter and their situations better. I better not theorize how to handle these at this stage.  Anyway, now that the patient has experienced a ‘reward’ for the act, I predict she would continue to seek it. This is not my guess .It is the law of effect in maintaining behaviours called ‘operant conditioning’. I suspect that the mother understands this risk. She can never be in peace.

They left, temporarily relieved. I know God does not test us beyond what we can stand. I hope and pray they do not fail the test. We can imagine but we would never know tough it is. How could one help the patient live in safety? What should this mother do now, to prevent such happenings? What are her options given that are such daughters have right to liberty granted to them by International law like Convention on Rights of People with Disability? Where do local laws/ policies stand in situations like this?

Do comment and help me write the responses to the questions stated above in my future posts.

Posted in behavioral therapy, challenge, children, distress, ethics, law, love, mental retardation, schizophrenia, stigma, women's issues | Tagged: , , , , , , , , | 11 Comments »

‘Agreement’ among Psychiatrists and Legal proffessionals:Towards better Mental Healthcare and Justice

Posted by Dheeraj Kattula on October 12, 2009

Consider a psychiatrist who diagnoses ‘severe depressive disorder with psychotic features’ in a patient. He makes diagnoses like this everyday. How can we be sure that he is making a right diagnosis? How do we judge? Usually this would be based on his qualifications and training. Isn’t it? What is training? How does training help?

A psychiatrist learns a set of criteria based on which he makes the diagnosis. He learns this process by observing senior psychiatrists till he begins to identify signs and symptoms just like them. This happens to every student of psychiatry. So at the end of a long period of training every student would probably make same diagnosis on seeing the same patient. Practically this does not happen in all cases. It would be in ‘typical’ cases but not all cases. When two doctors see a patient separately and diagnose a patient to have an illness or clear him as not having an illness, we can say they are in ‘agreement’. When one diagnoses a illness and another clears the same patient as not having an illness, we can say they are in ‘disagreement’.

The criteria for diagnosis are formulated in such a way that agreement of responses is made possible to the maximum extent. For example, we can study two psychiatrists by making them assess 100 patients among whom there are few patients with depressed mood. Each psychiatrist is asked to evaluate for depressive symptoms. At the end of the study usually psychiatrist A and psychiatrist B would have agreed on certain people to have depressive symptoms and certain to not have depressive symptoms. There would be certain people whom A would have said to have depressive symptoms which B would have cleared them off as not having depressive symptoms. There would be another set of people whom B would have said to have depressive symptoms which A would have cleared them off as not having depressive symptoms.

If B was a 10 year old boy who would toss a coin and call all ‘heads’ as ‘depressive symptoms’ and all ‘tails’ as ‘no depressive symptoms’, there would still be some agreement between A and B. This is because of chance. Isn’t it? We can adjust for chance ‘agreement’ and find ‘true agreement’ by calculating a statistic called Kappa. If Kappa is high, it means that level of agreement is high.

Lately, I have found many lawyer friends. I discuss legal issues with them. I have been learning much from them. I also bore them with theoretical questions like this one- what is the level of agreement among judges while sentencing convicts?

For example there are 100 convicts. How would Judges A and B sentence them? There would be few to who both might give strict punishment. There would be few for who both would give liberal punishment (not so strict). There would be few, for whom one would give a strict punishment and another would give a liberal one.

Judge A

Punishment strict

Punishment liberal

Judge B

Punishment strict

🙂

😦

Punishment liberal

😦

🙂

Intuitively the level of agreement ought to be high, if one were to have faith in the legal system. The smiley in the table indicates that there is no problem when there is agreement.The sad face reflects feelings when a person could possibly be getting the wrong sentence.

To my surprise, many of my lawyer friends felt that agreement would probably be less. I was also shocked to see that they were comfortable with this lack of ‘clarity’. I sensed how other doctors perceived the low agreement levels in few of the psychiatric diagnosis. But ‘psychiatric diagnosis’ is of less significance than a ‘sentence’ in court. A disagreement in psychiatry might mean a patient might take a medicine for few extra months. Whereas a disagreement in a court of law might mean a death sentence for someone!!! How can lawyers be comfortable with this sort of system?

There is another principle which operates in the legal system. That principle allows a party to ‘appeal’ to a higher court. Just in case a party feels justice was not delivered in a court of law, then the party could appeal to a higher court. The higher court would look at evidence again and pass a fresh judgement. Courts are organized in such a way that there are 3-4 levels till which a case can be taken up. How on earth does this help? Let us see it- statistically!

Let us assume an average Judge has 90% accuracy in making his judgements. If he were to sentence 1000 people, he would have 900 correct decisions and 100 errors. If these 100 go to a higher court, 90 sentences would be corrected and only 10 errors would remain. If these 10 go to an even higher court 9 would be corrected and only 1 would end up getting a wrong sentence. This model assumes that every judge has 10 % error in judgements. The truth is that as we move to the higher courts there would be judges with less error rates. This is because higher courts have judges with more experience and better track records. This ensures that justice does get served.

Hmmm… Now I know realize why they were comfortable. It reminds me of what I do when I have a diagnostic dilemma in an atypical case. I would ask my peers to see the patient. If we ‘agree’ I assume that we are right. Something like this happens when courts use a ‘jury’. What do I do when my peer and I ‘disagree’? We ask a senior’s opinion. It would be usually someone with more experience and knowledge. Hey…That is like an ‘appeal’ to a higher court in the legal system. What can be done if the agreement among judges at higher courts is low? Make the law more comprehensive and clear! This is similar to what psychiatric researchers do, while revising the diagnostic criteria.

Wow! Is it not amazing to see commonalities in approach of lawyers and psychiatrists? We also share a common desire for our clients. That is the client’s well being. But, it is funny that we don’t seem to understand each other in our arguements. We would…soon 🙂

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