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00:00our job is hardcore it is life and it's death everything we do relies on this bond between us
00:17you're okay you're okay you have to be comfortable in high stress situations
00:32in this immersive series you're in the hospital how much do you want to tell me what drugs you want
00:37to win we take you into the theaters and wards of sydney's busiest hospitals
00:42and into the world of nurses nurses are the backbone of the hospital through their eyes
00:50you'll see life big deep breath in
00:56death unfortunately we can't save her
01:05and everything in between coughs colds and sore holes
01:08welcome to the front line
01:15of one of the world's toughest it's all right darling we're looking after you okay
01:20a most trusted professions
01:24was scary hey nurses are superheroes without capes just in scrubs
01:30this time on nurses an intoxicated patient jacob fights for his life jacob open your eyes you're in
01:46hospital mate a graduate midwife is put to the test hopefully we can break your waters so just going in
01:55now and a parkinson's patient in surgery and awake everything fine it's pretty awful actually
02:10st vincent's hospital has one of the busiest emergency departments in australia you're in the emergency
02:15department it's a vincent's over 50 000 patients come through its doors seeking urgent medical attention
02:23there is no such thing as a typical day in ed you see people with headaches you see people with
02:28injuries you see people have been in car crashes intoxicated people your drug affected people
02:35anything comes in the door head down bum up get in and get it done
02:43my name is carly and i'm a registered nurse in the ed department when i was younger i was the paper
02:49girl at the local hospital i was probably about eight or nine with the old cart
02:55and the whistle oh look who's here here we are i looked up to the nurses and i thought that's
03:00something i would like to do all right do you want a hand yeah sure all right i'll send these bloods
03:06where would you be without nurses up the creek without a paddle
03:10carly's shift is just beginning and a major trauma is on the way
03:23it's carly in ed can i have a major trauma recess two please thank you a 28 year old man has been
03:30discovered unconscious after a night of drinking recess three which is the lowest score you can get
03:36so it's the most unconscious you can be he's got an evident head injury so it doesn't sound good
03:42if he's not collared we'll collar him when he gets here
03:49it's a 28 year old male um history of going out last night drinking with a friend they came home
03:54around 2 a.m friend reports he fell to the floor all we can find is an abrasion on his left eye
04:00friend denies any drug use just says alcohol and doesn't have any other medical history on him
04:05where we're located we have a very big drug and alcohol catchment area he does have equal pupils
04:10they're about four meals he's just having a little vomit there just open up for me mate that's it the
04:15worst case scenario is that he could aspirate so he's going to vomit he's got no gag reflex it's going
04:20to go straight back into his lungs and give him ammonia and essentially he'll die from it jacob open your
04:27eyes jacob open your eyes you're in hospital mate jacob yeah very strong come on man open your eyes
04:38open your eyes buddy jacob hold on buddy yeah we'll have to flirt us today i think i've got i've got
04:47ketamine you want to ask yeah oh careful everybody please so we can get an arm so we can get a
04:57second line it's quite combative hold on buddy jacob 100 100 all right jacob
05:08the neurology department at st vincent's hospital treats an average of 1500 patients a year we're
05:22just being super super cautious the dedicated team performs complex brain surgeries you can see the
05:29brain pulsating away to improve the quality of life for those suffering from a number of debilitating
05:35conditions neurosurgery when it's successful it can be life-changing but we're working within
05:40millimeters and one wrong move can be disastrous
05:53this admissions
05:57ann is one of over 80 000 australians living with parkinson's disease
06:03a neurological movement disorder with symptoms including tremors rigidity and uncontrolled
06:09movements parkinson's to me is all the things i can't do like even getting dressed is difficult
06:15i can't write goodness me writing is terrible you know i don't like to go out walking very far by
06:22myself in case i fall over it sort of makes you feel incompetent
06:26today am will undergo a revolutionary surgical procedure called deep brain stimulation she will be
06:35awake during the entire operation
06:40for deep brain stimulation the idea is that we insert electrodes into the part of the patient's
06:45brain that is not conducting electrical signals correctly and we stimulate that area so the goals
06:51of deep brain stimulation for parkinson's is to improve our patient's quality of life by alleviating the
06:56symptoms that are hampering them doing their normal activities scrub nurse naomi has over 20 years
07:03experience i am in the specialized field of neurosurgery and has assisted in hundreds of deep brain
07:10stimulation procedures yeah you feeling okay yeah good okay if you need anything just yell out it's hard
07:16sometimes because you can see the fear on some patients faces and we try and make that a bit easier for
07:21them whilst naomi scrubs in anna is prepared for surgery which involves shaving her head a necessary
07:30step to minimize the risk of infection having the hair cut off it's daunting it's up there with all the
07:36things i'm not happy about but it's a small price to pay the mri that was done prior to surgery that looks
07:45nice ann has been fitted with a frame that will keep her head perfectly still during the delicate
07:52procedure principal neurosurgeon dr benjamin jonka and neurologist dr stephen tish will map the coordinates
08:00in her brain to precisely implant electrodes okay and let's scroll up from there by the way
08:08yeah it's still i think that's okay yeah it's still reasonably lateral over the next four hours a team
08:16of five doctors and four nurses will try to literally switch off the effects of parkinson's
08:24the surgery is unique in that the patient is awake for the majority of the procedure
08:28does your neck feel okay there ann yeah i think so yeah excellent can we get a swipe of prep and the local
08:34gloves and you're going to feel something cold on your head in the moment dr jonka will inject local
08:42anaesthetic into ann's scalp so that she won't feel the incision he needs to make in order to access her
08:49brain okay a little bit of a sting and i'm just going to put a little bit of extra local into your scalp
08:54now but the brain itself has no pain receptors so the implantation of the electrodes will be painless
09:01our patients awake for the procedure so that when we put the electrodes in we can test that they're
09:06actually a in the right place and that they're actually alleviating the patient's symptoms
09:13and real-time responses to questions and repetition of physical movements during the procedure will be
09:20crucial being awake while someone's drilling into your skull and putting electrodes into your brain
09:25it's pretty daunting how is that and a bit strange i think all of us imagine that the patient could be
09:33a family member or a loved one and we do try and make sure that we treat them as we would want our
09:37family members to be treated
09:47if we can make a patient more comfortable in any small way we'll go out of our way to doing that
09:52because it's such a strange and scary experience for patients being awake
09:59and have you got our cables dr yonker guides recording micro electrodes into the target positions
10:06which can be up to seven centimeters deep into ann's brain
10:13and that's the sound of your brain you can hear there and in a couple of minutes we'll hear some
10:17different sound as we enter the subthalamic nucleus it's the most perilous part of the procedure due to
10:26the risk of seizure brain bleed or even stroke the stakes are high one wrong move can have catastrophic
10:34consequences
10:47how is that and a bit strange in the surgical theater of st vincent's private hospital parkinson's patient
10:54ann is 90 minutes into a deep brain stimulation surgery during which she must remain awake
11:01and that's the sound of your brain you can hear there and once we've made the hole in the skull
11:07with the drill we're able to insert something called a micro driver into the brain which places
11:12the electrodes where we want them to if the surgery is successful the electrodes will override the
11:18malfunctioning part of ann's brain that is causing her parkinson's symptoms so i'm just going to take
11:24your right hand out just to check a few things and neurologist dr tish conducts physical tests to
11:31establish the baseline of her symptoms which include rigidity and tremors it's a bit restricted isn't it
11:38rigidities are two full range moderate severity but there is a tiny bit of tremor grade one
11:45so and we're going to do some test stimulation now what we're looking for is to see if it has any
11:59effect on that bit of rigidity that you still have and also to look and see if there are any side
12:04effects okay so 0.5 million very small amounts of electrical current are fed through the electrodes
12:13that are in place deep within ann's brain everything fine any pins and needles or numbers anything of
12:19that sort look left right still okay there's no more rigidity so we'll be mainly looking at side
12:30effects now 2.5 go to three smile big smile go to 3.5 the amount of electrical current is increased
12:41gradually it's a very fine line as too much current can result in difficulty speaking numbness and
12:48physical discomfort for ann sometimes there's complications that can occur straight to four
12:54oh it feels weird all over and look left right
13:09hold on babe in emergency jacob carly and the team have called in security to help manage an
13:20intoxicated patient with a suspected head injury who's becoming increasingly agitated jacob all that we
13:29know is that last night he's been drinking and then he was found on the floor this morning and he's
13:33quite combative and agitated and not waking up it looks like he's got some kind of head injury so
13:38it'll need to get sedated
13:43there's a hundred of ketamine just gone in so yeah lots of vomitus around the earway with the patient still
13:49vomiting seven hours after his last drink the decision is made to sedate and intubate him
13:56to prevent suffocation and allow the team to examine him safely
14:01when you guys are ready i think we'll make the tube 100 of rock yeah okay
14:12okay rock's going in right now the decision to intubate someone is never taken lightly because it is
14:18quite invasive procedure and there are a lot of risks involved you know trauma to the mouth trauma to the
14:23throat trauma to the chest cavity trauma to the lung you can cause someone to have an ammonia just by
14:28putting them on a ventilator so it's always a last resort can someone have a listen to the chest
14:38cure
14:42with jacob fully sedated and safely intubated he's sent for a ct scan to determine whether the fall he
14:50had in the early hours of the morning has resulted in a spinal injury or a bleed on the brain
14:56okay we're all ready to go yeah ready yeah
15:06he's acting like he does have a head injury he's at a decreased level of consciousness he's agitated
15:10he's not waking up he's doing non-purposeful movements so all of those signs of a head
15:15injury hence why we're going to scan his head and just see what's going on
15:19they're also going to scan his neck because he might have injured his neck at the same time as
15:25he fell okay so we're rolling on three one two three and down one two that's great yeah okay everyone ready
15:38it might just be a lot a lot a lot of alcohol but it'd have to be a very lot of alcohol for
15:42those symptoms
15:50in surgery at st vincent's private hospital
15:54go to 3.5 dr tish has been slowly increasing the intensity of electrical current through the
16:01electrode implanted deep into ann's brain that last little bit of testing was a bit unpleasant because
16:07we're just probing the level for where side effects occur okay
16:15do you feel fine you say the days of the week monday tuesday a bit louder so everyone can hear
16:25so ben there's a very good effect at target at 0.5 milliamps that's very loose can you see that
16:30rigidity is just about disappeared it's amazing seeing the instant impact i mean you can really
16:38see what we're doing what we're achieving
16:46see that yeah that's better yeah look at that that's a definite pop there isn't it very big
16:51so the tremor seems to have disappeared so tremors down to a zero does that feel looser that arm now
16:56does feel looser it feels like you've got more use of it yeah it's starting isn't it yeah it is
17:02so it's a lot looser than before we started the operation it's great it's definitely a source of
17:07hope for the patient they obviously notice the immediate effects of the stimulation while they're
17:12in theaters and it just i mean it's not a cure but it certainly improves their quality of life for
17:16hopefully many years both of those brain electrodes are now in and secured now we're just
17:22going to give everything a good clean and then close it all up the electrode stays in place after
17:37the operation because that's what actually overrides the electrical signals in the brain that are not
17:42firing correctly and it stays there permanently for the rest of their life it's always great to see the
17:48the patient responds so well it's a really rewarding experience for all of us the whole team
17:55after four hours of surgery am will now be transferred to the intensive care unit for
18:00monitoring and just brought you up to intensive care okay you've done very well although the surgery
18:07has been a success the care she receives in the coming days will be crucial to her recovery
18:13she's not out of the woods yet in emergency carly is anxiously awaiting the results of a ct scan for her
18:23patient who fell while intoxicated
18:27so we're all done okay thanks thank you
18:50a great outcome is someone will come in with an issue and it's not life-threatening and we can
18:55treat them and get them back home again that's good news for jacob his scans are all clear the best
19:01explanation for his deeply unconscious state would be alcohol consumption yeah that's better one two
19:08why were we ever trying to do it with two people in the first place he's at 230 pounds for women that
19:12can't i do think he'll be okay because you know his blood pressure is rising and his limbs are starting
19:17to move so they're all good signs that someone's trying to wake up
19:27jacob will be transferred to the intensive care unit for observation overnight
19:33whatever is the issue we greet everyone with open arms we're here to help
19:45the hospital
19:56a 30-minute drive from st vincent's is the maternity unit at the martyr hospital
20:02best sweethearty speaking there a roster of 90 nurses work around the clock in the specialized area of
20:10midwifery it's when things aren't going to plan particularly in labor if there's any complications
20:16baby's heart rate drops or we're in a bad position people appreciate you being there in those moments
20:22to support them and it reminds you again you know that you are making a difference
20:36my name's heidi and i'm a new graduate midwife it's cold and rainy out there so it's a good day to be
20:43inside i've started at the mater at the beginning of the year morning susan i think it's great career to be
20:53involved in because you're seeing start of life henry hello it's beautiful i would like to have a baby
21:01one day but for now i think i'll stick to my dog i'll wait a few more years
21:12i just put the stamps for the vitamin vitamin k and then as a first-year midwife heidi has been
21:19taken under the wing of senior midwife jeanette jeanette's beautiful she's been my preceptor since
21:26i started she's had so much experience in midwifery in chile and in australia you can tell she loves her
21:34job heidi is preparing the birthing suite for a third-time mum who was due to have an induction and
21:45within the light we have a powerpoint inside so an induction is bringing on labor artificially that
21:53means that if they want to listen music there's a few reasons why you might have an induction
21:57sometimes the placentas don't work as efficiently once a baby's overdue if the woman gets gestational
22:03diabetes or any other complications it's a big day for heidi laura how are you going we're just down
22:09here in um room four that's all good she'll take charge of laura's care while jeanette supervises
22:16when needed we'll monitor bub for the first bit and um then we'll get the induction started yeah
22:24and bub's been moving around a lot this morning not heaps not heaps okay not heaps this morning
22:30not much room anymore and are you happy if i have a quick power where he is sorry my hands are very
22:36cold there's a major emotional role that we play with people forming those relationships often quite
22:42quickly with people who's looking after his little brothers today oh daycare hence why choosing today
22:48we're just trying to keep them in routine and yeah yeah that connection that you make with someone
22:53even in a short period of time there's a special part of this job i think our three and a half year
22:58old gets it like i told him my baby has a present for them oh that's nice and our two-year-old see yeah
23:04yeah laura's labor will be induced by breaking her waters so we'll put the monitor back on bub
23:17for about half an hour or so after we break the water and when we break the waters we'll give your
23:21cervix a nice sweep as well which will also probably irritate it a bit and yeah hopefully bring on some
23:27contractions heidi has watched jeanette perform the procedure but she's only done it herself twice
23:34before just check baby's trace and baby's heart rate's looking really good so we're going to go in
23:39and do an examination and hopefully break our waters just feel some cold jelly yeah and hopefully we can
23:46break your waters so just going in now yeah tickling bubba's little head
23:57so
24:12heidi senses something isn't right
24:27graduate midwife heidi is preparing to induce a mother's labor by breaking her waters when something
24:37doesn't feel right heidi asks jeanette for a second opinion
24:46heidi is going to be cold okay it's a little bit of pressure there
24:55heidi's instincts are right
25:05what happened at the moment i don't want to rupture the membrane because what i found the baby has a
25:11little hand here
25:15i can feel the little fingers in there saying hello so baby is basically sitting with their hand on our
25:21head if the cervix was here obviously that's not an ideal presentation we will just call your doctor and
25:27ask him what he wants to do
25:33laura's obstetrician is called in to check on whether the induction can proceed given the baby's position
25:43maybe i'll just do an examination and see if that hand's moved it looks like it's at least
25:47beside the head and when there's fingers in the front the pressure
25:58it can easily get through to the membranes
26:00the obstetrician confirms that heidi's hesitation to break laura's waters was right when there's
26:16something if you like in front of the head what the risk is things like cord prolapse
26:23the doctor is sending laura home in the hope that the baby moves on its own in the coming days if
26:28you've had a date set and they've been planning to come in and have their bob and have to go home
26:33it would be really difficult take your time okay yeah it's not a new show the babies they can do it
26:40all the time but at the end of the day mum's safe and bob's safe so that's the most important thing for
26:45them yeah see you
26:59one in seven australians is over the age of 70. he is a lot more tired than normal the aging
27:18population's increasing need for healthcare has seen a rise in elderly patients requiring emergency
27:25medical attention every day can be a big challenge in the emergency department we certainly see a fair
27:32share of elderly patients it can be difficult
27:37paramedics have brought in an elderly woman hello hello the woman was found by a neighbor
27:55on the floor of her home where paramedics suspect she had been for several days do you know where you
28:01are at the moment so the lady in here 76 year old female she's been found at home really lying on the
28:08ground with like a magazine stuck to her legs her legs are really full of sores
28:15we can't feel the pulses in one of the leg because it's so necrotic looking there's actually some
28:21maggots crawling around her leg and she's now incredibly like septic her blood pressure is really low
28:28she's really quite sick my name's iromi this is darren you're at st vincent's hospital can you try to sit
28:38up for me
28:46is that sore
28:49is that painful
28:52she's not really following it no it's not following instructions
28:54she's got probably something called a hypoactive delirium as well which is
29:00probably exacerbated with her infection so there's confusion acute confusion the patient's confusion is
29:08a serious symptom of sepsis a life-threatening bacterial infection that if not treated can lead to organ
29:16failure and death we're obviously incredibly concerned about the legs one of them is no pulse so she might
29:21end up having to go for an operation and you know she might end up losing the leg and so it's pretty
29:27serious i'll get the antibiotic started the patient is given iv antibiotics and fluids as the team races
29:33against the clock to try to save her legs and prevent her suffering septic shock a significant
29:40drop in blood pressure that can lead to heart failure so we're just trying to give her a fluid
29:45resuscitation but she's non-compliant with keeping her arms so that's why i'm kind of holding her arms get
29:50these fluids in to try and improve that blood pressure you know 67 systolic's incredible long
29:57someone who's mid-70s female reasonable weight you're expecting about 130 140 not that if she
30:07continues with her blood pressure that's only so long she can handle and then she'll crash
30:20on the 10th floor at St Vincent's private hospital neurologist Dr Tisch and neurosurgeon Dr Jonker are
30:30checking in on Parkinson's patient Anne following her deep brain stimulation surgery
30:36how are you going, can't see it just stimulating sort of mid-array contacts one and nine
30:44with the electrodes now implanted in ann's brain the amount of current passing through them can
30:50be fine-tuned remotely rigidity at 0.3 i think it's clearly providing excellent benefit how do
30:59you feel your parkinson's is at the moment well it doesn't feel it that's there actually that's
31:06good good stuff excellent the recovery is rapid it's actually amazing how quickly people can
31:17recover from this particular procedure given that it's brain surgery
31:24after seven days in hospital it's finally time for ann to go home to her husband henley
31:31you did very well no drains walking as what physio has recommended just take it easy for the first
31:38two weeks two weeks naomi she might ring you like just to check on your mom when you've been settled
31:45here the reward of being a nurse for me is to make a difference i hope ann has a better quality of life
31:50and can go back to doing the things she loves doing having my hair shaved off was probably the most
31:57confronting thing of all although when i look back on it it doesn't really matter now i don't really
32:02care i quite like the feel of it i run my hands over it all the time and it's not so bad i wish you
32:10all the best yeah all right take care yeah i guess when i look back i wasn't very well when i first came
32:20in here i certainly feel quite well i feel i can get up and walk around easily and i don't think i'll get so tired
32:30i feel quite liberated actually i feel good i hope to feel a whole lot better for a whole long time now
32:47you're in the emergency department it's at vincent's in the emergency department darren is treating an
32:57elderly sepsis patient you've got the really bad infection in your legs the severe infection has
33:05caused confusion and delirium leaving the woman unresponsive hello yes first words you've said so far
33:16but after administering iv antibiotics the team finally has a breakthrough where do you live about
33:27where do you live
33:31in australia yeah
33:37well
33:38in darling point darling point that's good that's right
33:47and do you live alone at present yes at present yes okay
34:00it makes us feel better that she's certainly more alert despite that blood pressure
34:04and when i'm feeling our heart rate is it's strong so that's reassuring i'm feeling a lot better that
34:11you're talking to me now
34:14because you weren't talking at all for a good two hours
34:19so that means that something that we're doing is making you better i've worked with darren for
34:25just over a year and a half he really does care you can hold my hand if you want one oh my there we go
34:32he wants the best for everyone can you move your toes move these toes for me
34:37are they sore yeah no wonder i remember when i was a student nurse one of the nursing assistants back
34:48home in scotland she had said to me you know that woman over there and i looked over and it was like
34:54an old woman and she's like you treat her like it's your grand and you remember that throughout your
34:59career and you'll do well and i guess i've always kind of just kept that
35:08this is in one leg or two days two i know
35:17they managed to contact the neighbor that's been looking after her she is a lady that lives alone
35:23she suffers from agoraphobia so doesn't leave the house normally the neighbor does all the care
35:28she's got sons overseas but i don't think there's good contact there at all and it sounds like
35:33she's just been left to on her own for quite a while with her blood pressure still dangerously low
35:39and the infection in her legs a serious cause for concern the decision is made to transfer the
35:44patient to the intensive care unit it's so lucky that the neighbor found her and she's going to need
35:50a lot of nursing care yeah she's going to need a lot of intervention this would probably be one of the
35:56worst dresses i've ever did they're awkward though yeah it happens everywhere you know old people
36:03with no family around no one there for them it's just not the way it should be really but there is
36:08so many old people at home with no support now that we've got this patient with us we can really try
36:17and get her better because we've got her in the hospital system now we can try and get services there
36:22you know try and really support her so it doesn't happen again
36:41february 2021 and it's a big day at st vincent's australia's covert 19 vaccination rollout has begun
36:50and frontline medical staff will be the first to get their jabs the registration process are we
36:56ready to go with that sitting up now lovely senior nurses danielle and rachel from the disaster management
37:03team are in charge of setting up the hospital's staff vaccination program we've got the paper consent forms
37:09yes yes we'll write the temperature on those right let's go get the vaccine very exciting
37:18hopefully we'll do about 20 to 40 staff just as a bit of a soft launch while we get our processes in
37:24place danielle is miss corvid st vincent's and so between her and rachel i'm sure they'll kind of
37:30make sure everyone's vaccinated thank you the vaccinations they're extraordinarily secure location
37:37in the bowels of the hospital to the point where we had to get the local police to come in and do a
37:42site security assessment it's danielle's job to collect the vaccine vials from the pharmacy are we
37:49ready i'm so ready oh my gosh my role is incident response and disaster management a historic moment
37:57the last 14 months it's really just been leading the hospital's response to covid i think between
38:02our clinics and our amazing pathology team we've done over half a million covert tests
38:09i'm exhausted just talking about it here we've got a vial and now we're in covert vax
38:19the target today is 40 but danielle has enough to vaccinate a hundred members of staff
38:25to actually get to this point has required a lot of work from a lot of people hello everybody
38:37i have the vaccine oh it's here oh my gosh
38:44so in each one there's one vial and then the 10 labels
38:48it's a big event this is this vaccination is going to save the world so it's here obi-wan it's our
38:56only hope
39:00help me obi-wan is your help me astrazeneca you're my only hope
39:06rach is hilarious she's my fellow master of disaster we're complete opposites but we complement each
39:13other we have worked together for 17 years now we always say you know because we are very very
39:26different i she's slapping up sally on protocol patty i am very by the book and doing it properly
39:34just checking with me um yeah i'm shorter than you i can't i'm sorry love
39:42first dose as our first patient here yeah there's all right good
39:47there you go ah there it goes we gave our first vaccination and you know it's a really special
40:05moment for the service but also personally for our team
40:09to give us your vaccination it's so important for us to get the vaccination rollout really happening
40:20can i take a photo stephen the sooner we can get everybody vaccinated across the community not just
40:27across the health service the sooner you know the things that we used to take for granted can start
40:32up again we haven't socialized together forever because of covert i started drinking zero alcohol
40:38wine what's the point it's like going to maccas and having a salad it's been a hugely successful
40:45day for the team who've exceeded their target of vaccinating 40 staff i think we did 96 in total
40:52yes we will definitely be having a drink to celebrate our achievements today thank you we'll see you
41:00tomorrow i just need a gentle downward i'll push you in the pond please can you you were joking about
41:09the stairs i can't believe it was like seamless considering we thought maybe we'd do 20 to 50
41:16vaccinations and we did nearly 100 like i'm pretty happy cheers love we did it
41:23patients aren't numbers we certainly treat everyone as if it was our loved ones lying in that bed space
41:39it's awesome at the end of the day the work that we've all done has helped and saved a life
41:47in surgeries where the brain is involved i think we make a huge difference and it's nice to feel like
41:51we have made a difference to someone's life that's not pretty huge
42:00some aspects of nursing you're seeing a lot of death watching that moment of when baby's born
42:06it's beautiful it's beautiful just to see new life coming through
42:18you
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