Side Effects

By M.E. Macuaga

We sit across from each other to play the game Othello. Like Reversi and the ancient game of Go, the two-player match looks simple — but since I was four, you’ve drilled into me that winning takes strategy.

The pieces are round and flat like coins, black on one side and white on the other, each color representing a player. We set up our board, a green surface lined with an eight-by-eight grid, and place four pieces in the center to start: two of each player’s facing up, like a monochrome four-leaf clover blooming in a little field. We’ll take turns placing one tile at a time, trying to sandwich each other’s color to flip over as many as possible. Whoever conquers the majority of the board will win.

Black always goes first, so today I take white.

We begin.


You call me on a Tuesday in August. It’s eight in the evening in California; noon on Wednesday in Tokyo where you are, where the summer’s been one heat wave after another. My husband is catching up on NPR while doing the dishes, and our two boys, six and eight years old, are arguing over who has to shower first. I walk around with the phone against one ear and a finger in the other so I can hear you.

You’re calling from the hospital — the same hospital where Mama died — to ask me to cancel your flight. You’d gone in for a routine checkup but now they’re insisting that you stay. They want to run tests. A lot of tests, immediately. So you can’t go home, and you don’t know for how long. You sound rushed, worried, upset to miss your flight to come see us in LA. To miss celebrating your elder grandson’s ninth birthday together. But I sense there’s more: I picture you in the long bustling hall of examination rooms, wishing that you spoke better Japanese, or that the attending doctor spoke fluent English, or both. Having so many questions and being so uncertain of their answers.

Don’t worry Daddy, I say. I’ll take care of your tickets and figure out my work schedule and get over there as soon as I can. Okay, you say with your throat tight, Okay I have to go, and you hang up.


That was the last day you walked in the sun.


We sit across from each other playing Othello in your hospital room. You stare at the game board and our little clover, two white pieces and two black, mulling over your first move. Above you, an IV bag hangs from its pole, your silent guardian.

You hold a single smooth tile in your fingers, turning it over and over and over as you think. I see it flip from black to white, white to black, back to white again. Two opposites bound at razor’s edge, kami-hitoe, like genius and madness, or medicine and venom. Love and loss.

Flip, and switch.


How swiftly things could change.


Acute liver failure: also known as fulminant hepatic failure. A sudden loss of liver function occurring in a person with no pre-existing liver disease. Can be caused by a hepatitis virus or seen as an adverse reaction to medication. Complications include jaundice, internal bleeding, GI perforations, and the accumulation of toxins in the brain that result in personality changes, motor control issues and memory loss. Liver failure can sometimes be reversed with treatment, but often a transplant is the only cure.

This is what your doctors explain to us, sheepish but certain, the day I arrive in your hospital room. They say your liver is barely working; that medication could buy you a couple of years, hopefully more, but a full recovery would require an organ transplant.

So, basically, at seventy-eight years old, you are shit out of luck.


Every January, you made kumquat marmalade. The kumquat tree that you and Mama planted on our patio continued to blossom even after she was gone, and you relished in picking dozens of its small sun-colored fruits, slicing them into slivers as thin as only you could make them. I see you in my mind, hunched over the cutting board with your reading glasses perched on the tip of your nose, in your blue cotton scarf and coffee-colored alpaca sweater vest that Abuelita knitted with hands shaped like yours.

You always designed labels for your preserving jars and liked to ask me, your only child, for my opinion on layouts. I found it hard to answer because whether you put the graphic art of the fruit above, below, or behind the words Javier’s Home-Made Marmalade, these choices paled in priority compared to the countless other problems crowding my brain, like which new babysitter I should hire or where the hell I’d be able to pump in privacy at my new job. Eventually you would move on without me, make your own decisions; you’d painstakingly print the labels, shades of orange and marigold and a touch of green, carefully aligning and smoothing them onto the jars before giving them away to close friends and neighbors like the Iwases and Kazamas.

Whatever remained of your most recent batch was stored in your freezer next to the pot-au-feu I made for you this past Christmas, from my last visit, before I returned to the States and left you alone. The jars are still there, another problem for me to solve: your marmalade and my soup, side by side, frozen.


I wake to an empty house in Tokyo, silent except for the grumbles and sighs of the city buses and trucks outside. For a moment I think you’ve left for work, off to teach English as a Second Language to can-do businessmen and industrious housewives. Your desk in the faculty room was always your home away from home away from home; you liked to get there early and prepare for your classes in peace.

But then it all comes flooding back: my rushed flight from LA to Tokyo, dragging my suitcase to the hospital, your jaundiced figure against the white sheets, your timid gratitude.

What the doctors told us.

The air is heavy as I plod downstairs. You were always the first one up, and for years my mornings were marked by the smoky scent of your dark roast coffee and the bubbly sputter of the percolator. A sound as gentle as your voice. Now, the kitchen is soundless: it’s on me to fill the space with noise and movement. I blast the faucet in the sink, rinse out the glass pot you left beneath it, pour two cups of water into the back of the coffee machine, then swing open the compartment to drop in a filter and fresh grinds.

But there’s a filter already in place — and nestled inside, atop a mound of damp grinds, are small circles of mold, green and fuzzy and full of life.

You made this coffee days ago. You had planned to throw away the grinds after returning from what was supposed to be a quick trip to the hospital. You never dreamed that I would find myself here alone, trying to make my own coffee. That I would find everything you left behind: your clutter-covered dining table, your dirty mugs and dishes, your grimy sheets, your grief that grew and grew and grew over the past eleven years without Mama. The mess of your loneliness, in every dark inch.

But I find all of it, because this is what happens.


You don’t always get to clean up your coffee grinds.


After several minutes, you make a decision: your first move. You place your tile next to our central clover, black side up, so it sandwiches one of my two white pieces with black. You flip the white to make three black tiles in a row; I’m left with just one white tile on the board.

It’s my turn. I sandwich one of your black pieces with white, shifting the balance again. We now have six tiles in total, three black and three white.

Back and forth we go. You, pondering every move before turning my tiles black. Me, quickly reverting your pieces to white. Our two-toned clover unfurls in tendrils across the board until it’s impossible to tell which tiles began as mine and which began as yours; over time, we become both opposites and one and the same, an ever-shifting mosaic of black and white.


Utsuri-kawari / 遷り変わり: the fleeting, imponderable nature of metamorphoses through time.


In the hospital, you begin to change. You start to lose track of time and it confuses you. You become paranoid. They showed the same program yesterday, you say, on edge. You’re angry at the small TV by your bed. Why are they trying to trick me?

I try to explain: It’s a daily travel show — it looks similar, but it’s different. But the footage on fishing holes does look like a repeat and for a moment I feel the world glitch, as though I’ve tumbled off this earth and into a strange universe, your universe, where all things are askew, all warped and wrong and against your will.

What are we doing in this hospital anyway? All you did was take a common prescription antacid. Your esophagus was bothering you and you wanted to be comfortable. You took the medicine as directed. You followed the rules, as you always did. Always. So how come we’re here?


Methylmethionine sulfonium chloride: an organic molecular entity found in green vegetables such as cabbage, kohlrabi, and kale. Effective against ulcers. A gastric mucosal protectant. Molecular formula: C6H14ClNO2S. Molecular weight, 199.70 g/mol. WARNING: skin, eye, and respiratory irritant.

I investigate the chemical compositions of common antacids similar to yours, trying to tame reality’s madness by reducing it to a formula. But despite your condition, and the lab work that points the dirty finger at your prescription, I can’t even find LIVER FAILURE listed as a side effect on any website or in any article. Apparently, it’s a reaction so rare that it’s unworthy of a cursory warning, not even the kind where the risks are designed to be disregarded, where the print is so small that elves would need a magnifying glass to read it. This complication isn’t supposed to happen, so why did it happen to you?






Half the board is now full, and my heart begins to ache, seeing more white tiles than black, your numbers dwindling with each turn we take. It’s your move, but you’re not sure where to go. Your jaundiced eyes gaze softly at the board, roaming over empty squares. Your search is simmering — you need time.

So I watch, and I wait.

Counting backwards, slowly, with each drip from your IV.

Back, to when you were well.

Back, to when Mama was still here to make us laugh.

Back, to when Mama first met you, the beginning of my beginning.


Once upon a time, a boy named Javier and a girl named Yoko were born at opposite ends of the Earth — Yoko in Japan, and Javier in Bolivia. For twenty-five years they lived and breathed 10,000 miles apart, but this distance was no match for fate: one day, beneath the Golden Gate Bridge, the sun broke through thick clouds of fog and they found each other at last. They fell in love, deeper and deeper with each turn of the moon, and shared their dreams, in their common language of English, of living freely together, forever.

But as with all grand fairytale romances, there loomed a great obstacle: Yoko’s father. He was jealous of his daughter’s newfound happiness, and saw nothing but misery in their future. He was also growing old, and determined to keep her safe by his side. He summoned her back to Japan, and cast a spell to bind her there, oceans away from her love.

Javier wept, aching to return to his homeland with Yoko’s hand in his, to the noble slopes of Mount Illimani, to the echoes of bombos and charangos like heartbeats in the Andes, to the strong embrace of his mamá and papá and his sisters and brothers and tías and tíos and beloved cousins. But it was not to be. Instead, he journeyed to Japan by himself, where no one spoke his native tongue, where his brown-olive skin and curly hair stirred up fears of the unknown. Yoko alone held him with her heart wide open; and though it enraged her father, she defied his will, and chose to wed her dark and handsome prince in her own homeland, so never again would a great distance come between them.

Yoko and Javier married in a Catholic church: a rare sight in Tokyo at the time. Yoko wore her long black hair parted down the middle and in a low ponytail beneath a simple white veil; her Western-style wedding dress had lacy sleeves and a hem so high a fairy Godmother might have brought her Go-Go boots. Javier wore a sensible suit with a pearly-silver tie. It was a modest ceremony; he was the only Bolivian there. His family back in La Paz shed tears of joy and sorrow, and sent their blessings across the world through a pair of golden wedding rings. Yoko’s father did not attend.

Together, the newlyweds found a small apartment in a small suburb of Tokyo, with a small window where they could see the sunset and a bustling bus stop below. Yoko gifted Javier a sweet Spanish guitar, so together they could create melodies to live by and sing serenades of hope. They honeymooned in Hakone and kissed all night beneath the blanketing shadows of Mount Fuji.

Ten months later, Yoko’s father died of a terrible disease.

Ten days after that, a baby was born.


I could have been an ambassador for you all those years ago: a human peace offering to end the war ignited by your rebellious romance with Mama, to calm her father’s fury and restore harmony with a chubby smile. But time was not on our side; I arrived too late. I missed my chance.

It was my first failure, accomplished from Mama’s womb.


Five minutes later, I’m still waiting for you to make your move.

Your long lashes bow toward the game board as you keep searching for answers. A five-year-old would know what to do, but you don’t see it.




I suddenly have the urge to scream, to kick over the board. I want to shake you and ask you what happened, where you’ve gone. But I don’t, because you’ve been fighting, too. Your body has been fighting to persist, just as we’ve been fighting all these years — to belong in a place that should be home and yet didn’t always feel like it.

And now, looking at you, I wish more than anything: that we didn’t belong here, in this hospital room.


Two weeks into your hospital stay, your numbers begin to improve. Albumin. Bilirubin. Your ALP, ALT, AST, γ-GTP, PT, LD, your letters, your levels. Progress is slow, but it’s progress nonetheless; your doctors are impressed. They speak of potentially switching you to outpatient care in another six weeks and we happily nod.

I research what foods are good for liver health. They’re all your favorites:






Fatty fish, such as salmon and trout.





I remember being measured by the alphabet. Twice a year, starting in fifth grade, I brought home report cards. Rectangular and yellow and printed with grids, they reduced my days to singular letters: A. A. A. A. A. Little mountain peaks all in a row; my tiny triumphs.

You took them in, inspecting each line like a jeweler checking for flaws in a diamond. If you encountered a minus sign marring the landscape, your brows would pinch. That’s when the interrogation would begin: “What’s this?” “How come?” A plus sign or two, and it was worse: “Why aren’t they all A+’s?”

But your tone was always borderline playful, so I could never tell if your relentless ribbing was shy pride disguised in humility, or straight up disappointment and disdain. You’re my daughter. What happened here? You never seemed to notice how I shrank with each failure, another mountain toppled. Or maybe you did. Either way, no amount of uncensored pride from Mama could fill the gap.


Now, at the hospital, it’s your turn to be reduced to letters and numbers — though in your case, the doctors remain pleased: you continue to improve. They note that in a month you could be ready to recuperate at home. You seem unsure at this, but you also seem eager to return to your own bed, to your students, to the familiar routine of your days. So, we talk, and we agree: I will fly back to the US for the month, to my children and husband and colleagues, and return again to Tokyo in time to escort you back to your newly-cleaned house. I promise to be a good ambassador for you, and a good caretaker. I will not arrive too late.




The clock crawls forward another minute — though it feels like ten — and you finally make your move.

My heart flutters in despair. You end your turn, leaving me at a great advantage. I know you wouldn’t have made this mistake if it weren’t for the toxins slipping through your struggling liver, swimming up into your brain. You had always been one step ahead, challenging me; if I ever surprised us with a win, I would beam proudly while you lit up with laughter. But now, with my easy victory in sight, all I feel is the sharp sting of tears swelling up. My father as I knew him, the father who was always smarter than me, who taught me to play tangrams and anagrams and all manner of made-up number games, is gone.

I do my best to keep faking the fun, as if you’ve truly stumped me, as if this match is a fair one, as if nothing has changed. You don’t seem to notice this collapsing inside of me, this avalanche, another mountain toppled. That my tears have broken free and are falling, pattering softly onto the game board, faster than the silent drip of your damn IV.

But how could you notice? After all, you are already gone.


Mono no aware / 物の哀れ: the pathos of ephemera. The appreciation of brutal impermanence,
mujō / 無常, and the heartbreaking beauty of never-lasting life.


We did our best to adapt. Five years after Mama died, during another sweltering summer, I took the kids — still babies, then — to visit you in Japan. Grief had hardened your back like a rock. You had been sleeping with a framed four-by-six portrait of Mama, along with her favorite multi-colored socks — you called them the United Colors of Benet-toes — placed on the pillow where she once laid next to you. You never again touched the calendar on your bedroom wall after she died; time had simply stopped. But your grandsons delighted you, and you never wanted me to worry, so we silently agreed to focus on them: You splashed in the kiddie pool with my two-year-old while I nursed the baby, or you cradled my baby, drenched in sweat, terry cloth limp over your yellowing undershirt, while I put the two-year-old to bed. Late at night, after they were both asleep, we cooled off together with lemon ice cups — your favorite and now mine — from the new convenience store next door. We had a new routine. New roles to play.


One night, we gathered for dinner with the Kazamas and Iwases. You sat, as always, at one end of the table, in your smooth high-backed dining chair, sipping your beer, quietly presiding over the meal and our chatter. But when I glanced over at you, a kind of vertigo hit me. Who is this man sitting at the head of our table? He looks nothing like the rest of us. He doesn’t speak our language. My brain labeled you as my father, but suddenly I couldn’t recall our shared history, our connection, how half of me must have come from you. I couldn’t even see our resemblance. When Mama was here, you were one half of a pair: she was part of you and you were a part of her. But in her absence, you drifted without a tether. I should have reached out then, to anchor you as she did, but I couldn’t — not without changing our roles yet again. Our future split into a chasm, and I couldn’t tell which was more terrifying: our shared grief and stubborn solitude, or the stranger that you’d become — someone I had to try to remember how to love.


Things you taught me:


Another failure: I am back in California, relieved to be at work where all my problems have solutions — not thinking about you — when your large intestine tears. A complication from the accrued damage to your liver. The progress you’d so diligently made had not been enough. Your doctors call me at four p.m. Pacific Time to relay this information; they rattle in my ear about the ripple effects of your rupture as well as the new medication they’ll be administering to stabilize the organ and stave off infections and pain as I stand in the kitchen of my company’s office, staring at the steel refrigerator and the coffee-splashed sign on it yelling “ALL CONTAINERS WILL BE THROWN OUT AT 3 PM ON FRIDAY!!!” Eventually I thank them and hang up and book tickets to fly home to Tokyo the next day. But then, at midnight, they call again. The meds are not enough, they tell me: Your fever has spiked, so now they need my informed consent to slice you open. Cornered, I say yes.

They patch you up while I fly back over the Pacific Ocean, hurry, hurry. I arrive in the rain. The surgery leaves you connected to six tubes and a catheter. You have bags hanging on poles for liquids going in, bags hanging on your bed for liquids coming out. You see me and smile.


How swiftly things change.


When I was five — you were younger than I am now — you kept a makeshift darkroom. It was a tiny, spare galley kitchen that you filled with cameras and canisters and trays full of chemicals, all cast in the rich red glow of the safelight bulb that was our never-setting sun. This was your quiet space, but if I asked, you would let me in, and I’d watch as you’d slip the photo paper into a developing tray. While we waited, we’d stretch and count, right arm up and bending to the left — one, two, three, four, five — then left arm over and to the right — six, seven, eight, nine, ten. In between moves, you would gently nudge the paper with rubber-tipped tongs as though it were a dumpling bobbing in hot broth, and by the count of twenty, an image would appear on its surface like magic.

Often I saw my own image appear, captured peering through a fortress of cushions or handing Mama a blade of tall Japanese silver grass; other times, you had corralled the crisp geometry of leaves or a stark winter sky cut by bare branches. I would snuggle up next to you in anticipation of each reveal. What would time unveil? What did you see, that now I would see?


Your torn intestine gave us a scare, but you leave the ICU in record time and return to your old room. Each day, your outgoing liquids become more translucent, healthier, and every two or three days, people in white coats and uniforms come to remove another tube and we cheer. I take you strolling through the hospital corridors, your IV pole rolling between us, my lanyard badge swinging over my sternum, showcasing my new identity: Daughter of the Patient in Room 603.


We were always most comfortable with something between us: an Othello board, a chess board, a game of Mastermind — Mama. Without them, our connection was fragile, on the brink of bursting from love, or fear, or both. We spoke in codes, quoting Isaac Asimov and Bruce Lee and the country songs you played in the car on our family trips, like when you drove me and Mama up the mountains of Gunma, taking each hairpin curve to the refrains of Kenny Rogers and Dolly Parton, Johnny Horton and Johnny Cash.


When Mama died, we spoke even less. Or maybe it was the same. All I know is, it wasn’t nearly enough. Sometimes underwatering is what kills the plant.




Now I am the one hesitating with every move on the Othello board, trying to staunch the damage but failing again and again; I can’t seem to keep my white tiles from consuming your black ones. You look tired, sitting across from me in your grey pajamas, and despite the afternoon sun lighting the walls I feel shadows falling everywhere, reaching for us. I should ask if you’d like to rest, but in truth, I don’t want to know. I don’t want to hear that you’re ready to stop. For once, I don’t want to win. I’m not ready for our game to end.


Three weeks after the surgery, your intestines rip open again. You are sedated and confused. The doctors tell me you called my name. Cornered again, I say yes to a second surgery. It leaves you in a coma, connected to fourteen tubes: seroma, ascites, urine, and bile coming out; blood, saline, morphine, fentanyl, and steroids going in. I sit beside you in the ICU and hold your hand, your skin soft and swollen and smooth. I read you a few lines from the mystery novel you’ve been rereading, The Cat Who Blew the Whistle, but I don’t get very far before my voice breaks. I’m sorry, Daddy. I call Father Sweeney from our church, who has looked out for you since Mama’s funeral; when he prays, you flutter your eyes. I see you. The rest of the time you sleep, brows furrowed in silence, in what I hope is a sign you are still fighting to survive. Yet in my gut, I know this isn’t true: you’re showing me, in the only way you can, your deep discomfort and disapproval of my choices for you.


I see you.


I want to defy you, for once. But my conviction turns to dread with each passing hour, with every damning beep and drip in the jungle of IV lines that entangle and strangle us.

You are a survivor, yes. But this is not how you want to live.


By day four in the ICU, your message to me is loud and clear: you are done with tubes, with being a bleeping, hissing, plastic machine. I understand that you will never make coffee at home again; I will not be taking you home alive. The head nurse in the unit confirms my understanding in confidence and encourages me to speak up because no doctor would allow you to die: It is their job to keep your heart beating and your brain transmitting something, anything. Later, I’d learn there were hushed conferences and heated words about my going AMA — against medical advice — but in the end, I get my terrible wish: we remove every tube except the most vital four.

You immediately unfurrow your brow, as if you can breathe again.

Finally, I got it right. I understood your silence.

Our smallest, largest victory.


I wash your hair the following day, gently combing your neat white mustache and beard. I change your surgical pads and kiss your forehead. I hold your cell phone up to your ear while your brothers and sisters and nieces and nephews speak their last words to you from across the world, from your homeland Bolivia, from where you’d once come so far to begin your life with Mama. I know you hear them — that you know you are not alone. I know you are saying goodbye.


Once, when I was eighteen, I spent a night out without calling. I’d been smitten with a charming artist, a man you’d never met — so when he took me to his shabby flat, I stayed. The next morning I took the first train back, before dawn, but not before you went looking for me. A few hours later, you returned, gathered your things, and went to work without a word, leaving me ill with guilt for days.


When I was a baby, you wouldn’t allow any cats near me because you were convinced they’d scratch my eyes out — even though you loved cats.


Also when I was a baby, you yelled at me when I tore up all the pages of I, Robot, just to feel the paper rip.


Soon after teaching me how to play the game Othello, you showed me the key to winning the board: capture the corners. But I still had to fight hard to gain any ground. Night after night, the dining table was my battlefield, our tiles quietly clicking in conflict as we turned them over and over and over until it was time to eat or sleep and Mama made us clear it all away.


When the three of us went out, Mama and I always trailed behind you, chatting away or stopping to admire little wildflowers on our path. You would forge ahead, at times stopping only to turn and call out impatiently; I would skip away from Mama to catch up, and she would hasten her steps to close the distance behind me. The three of us were a little inchworm, expanding, contracting, expanding, contracting, moving forward, together.


Every summer, we went fishing in the woods for rainbow trout. Mama would fry them up in butter with a dash of salt and pepper and you would pick the bones clean. I would dig into the eye sockets of each triangular fish head and wiggle out the tiny white orbs, collecting them like little pearls in a mint box.


When I was eight, you made me a dollhouse. It was two stories tall, with six rooms and an attic. You even filled it with tiny handmade furniture. The best detail was the miniature photo you hung just inside the front door — a replica of the black and white print in our real house. It was a favorite of yours, a scene you’d captured on one of our walks with Mama: an eternal moment on a snow-covered road in the woods, flanked by white-tipped fir trees, leading straight ahead into a bright, white haze.


at three a.m. your heart raced and raced and raced and raced and i scrambled to your side and squeezed your hand and held you and begged you not to go please don’t go i love you so much please don’t leave me alone pleasedon’tleaveme alone it’sokay it’s okay i’ll be okay i’m sorry i love you thank you i’m sorrythankyou thankyou thankyouthankyouit’sokayi’llbeokay —


Later, I noticed it was bright outside, so the sun must have come up. Which, when I think about it, was the strangest thing about that day.


Our board is almost full now: our game, nearly over. You try to flip a piece on your turn but your fingers won’t obey and the tile clatters onto the board. Oops, I say, and hand it to you, as though I am speaking to my son who is four again and I am teaching him to play Othello for the first time, as though you are four again and I am your mother.

I want to tell you that if we can just make it home together, I promise: I will care for you, feed you, bathe you, and change your diapers as you once did for me. I will make us roasted coffee in the morning, I will open our windows and dust off your guitar and scrub away all the mess. How swiftly things will change. We’ll pick up the pieces together, we’ll learn from our mistakes, steer each other clear of our worst regrets, lift each other up from our bottomless grief.

Instead, I help you find a spot for your recovered piece, and together, we reverse the white tiles of mine that you embrace with yours. White to black.


Now, it’s my turn:

Headshot of M.E. Macuaga

Originally from Tokyo, M.E. Macuaga is a Japanese/Bolivian storyteller who fell in love with writing at age six. She now enjoys creating in a range of genres and formats: as a film editor, director and executive producer, M.E. crafts both narrative and documentary stories for international film and television audiences; as a writer, her credits include an issue of the anthology series Spider-Man: Unlimited, a Japanese post-apocalyptic piece in the Yukinomachi Short Story Collection, and winning 4th place overall in the 2023 NYC Midnight Short Screenplay Competition, along with Honorable Mentions in both the Flash Fiction and 100-word Micro Fiction categories. A Hedgebrook writer-in-residence and a graduate of Stanford University and the USC School of Cinema-Television, M.E. strives to capture the intensities of life through vivid contrast – death and (re)birth, transience and history, the elusive nature of “home” and the struggle to find and free one’s voice. A mother of two, she is currently working on a children’s book, a short story collection, two novels and a memoir.

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