Miranda Bailey had just finished reviewing the E.R. charts her interns had been responsible for on their last shift when a series of screams made her turn and run full speed onto the E.R. floor.

She arrived to find Izzie Stevens crouched on the floor, her body curled around something as three security guards and two male nurses tried to subdue a clearly violent teenage boy. Bailey skirted past them as they moved the out-of-control patient to a corner, pinning him against it. Her hand fell gently on Stevens' back.

"Izzie, what happened?"

The blonde turned and looked at her, then eased back enough for Miranda to see that what Izzie had been protecting was the motionless form of their mutual friend.

"Oh, God, Addison..."

"He pushed her away from Mrs. Santos, and she hit her head," the intern reported.

Though she knew what her personal priority was, Miranda split her attention and scanned the E.R. to see how many other people needed help. Finding that her colleagues were already filtering in to care for their other battered and bruised coworkers, she caught sight of a bewildered Cristina Yang and called out to her as she motioned toward a terrified Sabrina Santos.

"Yang, I need you to take Mrs. Santos up to the Perinatal center and page Dr. Pollock to take over."

"But what happ--"

"Cristina, just do it!"

Bailey snapped, and she saw the intern jump to and rush toward the patient. Satisfied, the resident looked over at a still rattled Stevens.

"Izzie, I need you to page the chief, then you need to page Dr. Winslow and tell him to meet us in trauma two."

There was no missing the momentary confusion her last instruction had caused until Izzie began to put the pieces together and reached the correct conclusion. She shot a terrified glance toward Addison.

"Oh, my God."

"We're gonna take care of her." Miranda said the words confidently, hoping it would give them both reassurance. "Now go make those calls."

Izzie nodded and stood. Bailey then began shouting out demands for help so she could safely move Addison into the trauma room. She tried to focus on that, on making the best medical calls she could, in the hopes that her panic and fear for her friend would remain in check until there was time to let the feelings out.

*****

Despite his stubborn determination, Mark knew the moment he tried to pull his t-shirt over his head that his shoulder was going to force him to postpone his surgery today. Getting dressed hadn't been so bad because he had treated the joint with ice just before he'd gotten ready. But with the numbness wearing off, the twinge he felt was simply too great for Mark to deliver 100% to his patient. Frustrated, he eased his shirt back down, slammed his locker and headed out toward the elevator.

'Great,' he thought to himself. 'Here a few weeks, and you've gotten into a public brawl with Derek and it's cost you a surgery. Good going, Sloan. Classic.'

After speaking with his patient, the hobbled plastic surgeon decided he needed caffeine and fresh air, so he made his way to the E.R., planning to cut through the back entrance and out to the coffee cart.

A fleeting thought of getting Addison some tea passed through his mind before he remembered that Addison was off today. The chief had decided he wanted his favorite redhead to decompress away from both Mark and Derek until they could prove they could get through a day without another gross breach of professional conduct. Webber had also made it clear that another incident was grounds for suspension--for him and for Derek both.

But the chief had no worries. Mark didn't feel any pride about the screaming match or the slugfest that had followed, not when he'd seen how much it upset Addison. The sadness in her eyes had kept him up all night. It had reminded him of the way she looked in those first days in New York after Derek had left, and the fact that he was again a part of what had hurt her almost made him wish Derek had hit him harder.

The chaos in the E.R. caught him by surprise and made him do a double take. Trays were overturned, debris made up of medical supplies and paperwork was spread across the floor, and a mix of nurses, doctors and orderlies were tending cuts and bruises on themselves and each other.

When he spotted Izzie Stevens at the main desk on the phone, Mark made a beeline toward her to see if she knew what was going on. He reached her just as she hung up. She turned quickly, moving to leave, and knocked into him, nailing his injured shoulder. Mark couldn't stop a groan from escaping his mouth.

"Dr. Sloan, oh... I'm sorry. I was just... I have to..."

Mark bit back the pain in his arm as he looked at the young doctor, ready to tell her an apology wasn't needed. The tears on her cheeks and the clearly panicked expression on her face erased that thought, and he put a steadying hand on her arm.

"Stevens, what is it?"

She looked at him, then away and shook her head. "I... God, you should probably know."

"Know what?"

This time when their eyes locked, Mark felt his stomach drop. Something was very, very wrong.

"Stevens?"

"Dr. Shep--Addison. She... this guy went nuts in the E.R., and she stepped between him and our patient, and he... he grabbed her and... she hit her head. She's unconscious."

His hand reflexively closed more tightly and Izzie pulled on her arm out of discomfort. Mark instantly released her but stepped closer to her simultaneously.

"Where is she?"

Izzie turned and walked and he followed, his heart beating so hard it was making his chest ache. Why was Addison even here? She was supposed to be home in bed sleeping in, trying to forget about what gigantic asses he and Derek were. She was resting, taking some time to get her head together. She was safe, dreaming about Baby Girl Shepherd. She was not in a trauma room at Seattle Grace, hurt and unconscious.

Only she was. The door opened and Stevens stepped inside and Mark's eyes fell on Addison laying motionless on the examination table with Bailey beside her.

"Miranda?"

Barely sparing him a glance, Miranda waved him in as Izzie stepped over to check the I.V. that had been started. Mark held his breath as he watched Bailey turn to flip on the portable ultrasound machine behind her. She had already opened Addison's button-up shirt and placed gel on her stomach. With the machine now ready to go, the doctor drew in a deep breath and placed the transducer against Addison's belly.

The whooshing of the machine's sound waves emanated from the speaker, and Mark stepped closer, waiting for the rapid pounding that they were all hoping to hear. And then Miranda moved the instrument slightly lower, and there it was... the unmistakable beating of a fetal heart.

"145 beats per minute," Bailey reported. She carefully studied the image that now filled the screen before speaking again. "The baby looks okay."

Mark released his breath and moved to take up a secondary position beside the exam table. Izzie ceded her spot to him and moved over to the other side to assist Bailey.

"Did she wake up at all?" the intern asked. Miranda shook her head.

"She's got a gash on her scalp where her head hit the counter, but there's no intracranial exposure. I want Winslow to do a quick exam, and then we need to get her up for a CT to check for swelling and bleeding. Izzie, I want you to head to radiology, tell them we're bringing Addison up and we need a CT cleared. If they so much as look like they're gonna argue, you tell them to call me."

As the intern moved to do as she'd been ordered, Bailey suddenly called out to her again, stopping her from leaving.

"And, Izzie, don't tell anyone but the radiology tech what's going on. No one else for now, okay?"

Mark wondered if she'd question the command, but instead Izzie looked thoughtfully toward Addison and nodded.

"Okay," Stevens said as she headed out the door.

Turning his attention back to the motionless redhead, Mark watched as Miranda checked her pupil response by flashing a penlight as her fingers held Addison's eyelids open.

"Pupils are reactive and even. Good girl. You just keep giving me stats I like."

Bailey reached out toward him and Mark looked down to find a syringe and three vials in her hand.

"Make yourself useful. I barred the nurses to give her some privacy, so draw some blood for the lab."

Doing as he was told, Mark took the objects in hand and reached over to the box on the bedside table to grab some gloves. He carefully rolled up Addison's sleeve and gently pressed the needle into arm, nearly hopeful that the pinch would cause some response. But she remained quiet and still.

"What the hell is going on?" Webber asked as he pushed the door open. "My E.R. looks like a cyclone went through it and..."

Annoyance gave way to a look of such concern that had he not known better, Mark honestly would have thought that the woman laying there was a member of the chief's immediate family.

"Bailey?"

As Miranda gave the chief the cliff notes on what had happened, Mark kept his focus on Addison. Taking her hand in his, he leaned close and watched for any sign that she might be rousing. He knew the longer she remained unconscious, the greater the chances they were looking at more than a slight concussion. If the CT showed intracranial bleeding or excessive swelling, the treatments would undoubtedly put Addison's pregnancy in jeopardy, and he couldn't even think about what would happen to her if the baby didn't survive.

"Did you page Derek?"

The question came from Webber, and hearing Shepherd's name caused Mark to jerk his head up and swing it toward where the other two doctors stood.

"No, and you can't page him."

The chief looked at him with a furrowed brow. "Why the hell not?"

"Chief, they're almost divorced," Mark replied. He lowered Addison's hand so that it lay flat against her stomach and he moved to where Richard and Bailey stood. "She has been doing everything in her power to limit her contact with Derek. She wouldn't want him involved."

"She may not have any choice."

A stunned Mark felt his jaw drop at Miranda's words.

"You know she wouldn't want that."

"They're still married, Mark." Bailey sighed, clearly no more pleased about the turn of events than Mark, but she pressed on. "Addison is unconscious, and unless she wakes up, if there are decisions to be made about her treatment, Derek is still legally the person who has to make them."

"Bailey's right," the chief said. "Addison hasn't changed her next of kin designation with my office, which means it's still Derek."

Mark shook his head and threw his hands up in frustration. Addison was going to feel so out of control of her own life if she woke up to find that her secret had been revealed to the whole world, but it seemed there was nothing he could do to stop it.

"You know why this is a bad idea, Miranda. You know what's going to happen. He'll be a jackass about it, and she'll never get a chance to explain."

"I'll explain," Bailey stated, "and I'll make him understand. But we don't have a choice here, legally or medically. We have to do what's best for Addison as our patient."

Mark stared at her, incredulous, frustrated that she was right even though he hated it. Miranda looked at him sympathetically, understanding, but clearly determined about her course.

"What do the two of you know that I don't?"

The chief was shifting his eyes from one of them to the other, his gaze intense.

"You tell him," Bailey said as she headed for the door. "I'll handle Derek. And you get her up to CT as soon as you can."

With that, she left the room and Mark turned back to the chief who was now standing with his arms crossed, his face animated by a glare that spoke volumes about his level of aggravation.

"Talk, Sloan, now. What is going on, and why are we waiting another minute before we take Addison up to radiology?"

Mark took a deep breath and looked over at Addison. He silently apologized for being unable to keep his promise to her and then looked back at the chief.

"Because we're waiting for Robert Winslow so he can check on Addison... and her baby."

*****

The O.R. was always the one place that Derek felt untouchable. In surgery with scalpel in hand, he was in control, unshakeable and he could manage his emotions in a way that made him stronger and more decisive.

So it only stood to reason, given the week he'd been having, that he would arrive at work today to find that his first surgery had been canceled because the patient had developed an infection that would have to be treated before he could operate. That left him with a wide open morning, which meant way too much time to feel miserable about the state of his personal life.

It mystified Derek that the confidence and surety he could manifest in surgery could not follow him out of the O.R. and into the rest of the world. If it could've, maybe he'd have never become a coconspirator in the destruction of his marriage because he would've been able to clearly evaluate what was going on to make him push Addison away in the first place. Then before he'd hurt her, before she had turned away from him and to Mark, he could have told her what was happening and they'd have talked about it all and come to some conclusion together.

At the very least, there was the possibility that if all of the events in New York had been unavoidable, then when he had come to Seattle, he'd have had a plan--a divorce, starting over, or he'd have known he was just cooling off before he decided to give his marriage another try. He would not have come here and started an affair with Meredith, pretending that he was free to be hers when he wasn't.

But the razor-sharp reflexes and tremendous instincts that made Derek Shepherd a brilliant neurosurgeon were absent in Derek Shepherd the man. Which explained why, when Addison had first arrived, he'd been both furious and relieved to see her. His anger over her cheating had returned full force the moment she'd come into view, but he had also felt a surge of something like pride that he mattered enough to her still, after everything, that she'd come to find him.

It was no surprise it had taken a medical case for her to show up. They were both inclined to hide behind medicine when they were unsure in their lives. She had needed the excuse to face him. And he had needed the excuse to dismiss her arrival. But deep down, he'd known the truth.

He should've started preparing right then for the inevitable moment when she would demand a decision from him--a divorce or a fresh start, one or the other. But that would've meant figuring out what he wanted, and Derek hadn't been ready to do that. So he'd waited for the ultimatum to come. When it had, he was left to deal with the fact that while he believed he was in love with Meredith, he also still loved his wife. So he had chosen Addison, because she was the love he had taken vows with.

But he had never admitted the "love" part of that equation, not to anyone. He'd never told his wife he still loved her in all the months of their reconciliation. He had never confessed to Meredith that his feelings for Addison went beyond obligation. Conversely, he had also never been able to make himself give up on the "what ifs" he had dreamed of with Mer while he'd been pretending not to have a past.

Now he was faced with a new truth--or rather an old truth finally realized. He was still in love his wife--the wife he was divorcing, that he had hurt so badly she could barely stand to be around him. And honestly, until he had nearly screamed his declaration of love into Mark Sloan's face yesterday, he hadn't known that his heart still held so much for her. But now that he did know, what did he do with it? He had asked Addison for a divorce, broken her heart and moved into a relationship with Meredith before he'd even taken a full breath. Addison had started to move on, building a life without him, and despite the realization of the depth of his connection to his wife, Derek was still hopeless when it came to Meredith.

Which left him... where? Making a fool of himself getting jealous over Addie when he had zero right to interfere in her life? Upsetting Meredith because he couldn't let go of Addison?

It was a mess, one of his own making and one Derek knew he had to sort out, and soon. He could not go on like this nor could he continue to drag the women in his life through his sea of indecision. Something had to give. The problem was, Derek didn't know yet what that something was. He only knew that the next choice he made had to be decisive, sure and final, like the ones he made in surgery. This time, his life depended on it.

A yawn interrupted Derek's runaway thoughts and he stood up from behind his desk and stretched. Though he couldn't seem to think about anything else, the simple fact was he wasn't going to figure his life out in one day, not when it had taken him years to screw it up. He decided to look for a cup of coffee before rounds, then he'd review his charts and try to get his mind on the business at hand. But his journey was cut short when Miranda Bailey approached him in the hallway just outside his office and pulled him back into it.

"We need to talk."

Derek sighed. He had been expecting a smack down from the Nazi over his behavior and the embarrassment he had caused Addison. He had just been hoping for a little more time to get his head together before it came.

"Look, Dr. Bailey, I know that I acted like an ass yesterday, all right? But I'm..."

"This isn't about that," Miranda said, cutting him off. "We need to talk about Addison."

Derek paused, his momentary shock at not being verbally eviscerated disappearing as he took in the worry on Bailey's face.

"What about Addison?" he asked, almost afraid to hear the answer given the way the resident was looking at him.

"I had to call her in for an emergency and there was... something happened in the E.R., Derek and she was hurt."

He started moving without thinking, his body determined to get to Addison as quickly as he could, but Bailey stepped in front of him and blocked his path.

"What are you doing? I need to--"

"You need to listen to me," Bailey said, her hands taking hold of his arms. "You need to really listen to me and hear every word I'm saying to you, all right?"

Derek felt sick. What could be so wrong with Addie that Bailey was this upset, this concerned? God, she wasn't... she couldn't be...

"Just tell me she's okay," he said, his throat going dry as fear took hold of him. He dropped down into one of his office chairs and Miranda took the seat opposite him.

"She's stable for right now. She was pushed--thrown, really--and she hit her head and she's still unconscious. We'll know more after the CT."

Derek nodded. At least she was alive.

"Now I know that you and Addison are nearly divorced, but you're still married," Bailey explained. "You're still her next of kin, and if she doesn't wake up, we may need you to make some decisions for her."

He swallowed hard and tried not to throw up. God... if she didn't wake up...

"And there's something you need to know before you can do that."

His eyes locked with Bailey's.

"What are you... Is there another injury you haven't told me about?"

Miranda sighed and shook her head. "You need to know, before I tell you this, that right now, if you say something stupid to me about Addison, like how could she or you call her any names or you just say anything that pisses me off, I'm liable to hit you because my best friend is laying down there unconscious, and I have zero patience for any kind of foolishness. I'm giving you fair warning."

He felt his patience slipping, but Derek bit his tongue. He'd get nowhere trying to help Addison by getting into a fight with Bailey.

"The week you decided to leave Addison... she found out that she was pregnant."

Derek shook his head. He couldn't have just heard that right.

"What?"

"Addison is pregnant. 12 weeks. She was gonna tell you that weekend, but then... you wanted out. So Addison was letting you go. She was planning to tell you about the baby once the divorce was final."

He didn't know what to say. Bailey had cautioned him against saying anything stupid or terrible, but the truth was, he had no idea what to say. Addison was pregnant... with his--with their child? They were having a child?

"The baby... is it okay?" he finally managed.

"So far," Miranda answered. "Winslow was on his way down to check her over when I came to look for you."

After Bailey phoned down for an update on Addison, he followed her obediently to the elevator and they took the short journey to Radiology. As the car moved from floor to floor, Derek tried to wrap his brain around what was happening. Addison was hurt, she was pregnant and depending on what the CT told them, he could have discovered and lost the chance to be a father all in one day. As if that weren't enough to process, he was reeling from the fact that Addison hadn't told him. He wasn't sure what that meant, but it felt like further evidence that he'd become someone Addison not only couldn't depend on but didn't trust. And that hurt far more than the reality of the secret she had kept.

By the time they arrived at the CT Room, Addison was already inside the scanner. Richard, her O.B. Robert Winslow, Izzie Stevens and Mark were all in the viewing room with the tech, waiting for answers. Derek was slightly thrown to see that his fellow neurosurgeon Stan Quinton was also there.

"We're getting an image now," the tech said, and the collection of doctors all leaned in looking for a closer look.

"No depression--"

Derek and Stan spoke simultaneously, and they both automatically turned to each other. When Stan glanced toward Richard and the chief nodded, Derek realized that his job here was not that of a doctor. He was here as Addison's husband, as the person responsible for her well-being. Though part of him rebelled at that idea, reason told him it was for the best, and he stepped back, allowing Stan to move closer to the imaging screen.

"There's no depression," Stan repeated, "and it looks like the bleeding at the site of impact has stopped on its own. The contusion looks stable, but there's visible intracranial swelling. We need a lumbar puncture to determine ICP."

"No."

Mark's voice was loud in the quiet room, and all eyes turned to him.

"A lumbar puncture will endanger the pregnancy. Addison wouldn't want that."

"Increased ICP endangers Addison," Stan shot back.

"I think I'm well aware of that fact."

The two doctors began to argue in earnest as Derek's eyes shifted from the monitor to Addison and back again.

"Mark's right."

Silence took hold of the room, and Richard stepped toward him, his hand falling on Derek's shoulder.

"You're saying you want us to wait before we do anything else?"

Derek felt the weight of responsibility on his shoulders. Whether it was what she wanted or not, Addison and their baby's lives were now in his hands, and though Derek was full of doubt as to what he knew or didn't know about Addison as of late, the fact that his gut instinct matched Mark's had to mean something. And that instinct was telling him to give her time... she would be fine if he just gave her time.

"I say we monitor her for the next few hours, watch for any increase in symptoms. If she gets any worse, we'll consider the LP, but the swelling's not critical. We need to give her a chance to rebound on her own, without putting the baby in danger."

The decision made, Bailey, Stevens and Richard went about getting Addison settled into a room in the neurological critical care facility. Derek, his head pounding from all that had happened in the last 30 minutes of his life, left her in their trusted hands and nearly ran out of the hospital. He gulped in the fresh air as he made it outside and collapsed onto one of the benches.

Was it just last night he'd likened his life to a roller coaster? He felt as if the stunning rises and falls had now been eclipsed by death-defying loops. How was it possible that after all the years when they had wanted a child and never had one, when they had let the whole idea go by the wayside without discussion, that now was the time Addison was pregnant?

[i]"The week you decided to leave Addison... she found out that she was pregnant."[/i]

Derek squeezed his eyes tightly shut and dropped his face in his hands as he realized what Bailey's admission meant. Addison had been ready to tell him about the baby when he had walked in and announced their marriage was over. She could have still told him, but she hadn't. Instead she had packed her bags and walked away and given him the freedom he'd asked for.

He couldn't imagine that there was any untruth in the rest of the information Bailey had given him. Addison had planned to tell him when the divorce was final. He chose to believe that. Addie had bought a house, she was staying in Seattle--there would've been no hiding the pregnancy at some point. So, yes, she was going to tell him. But why wait until the divorce was final? Why was she so determined that it was okay to reveal her secret then?

"Are you all right?"

Mark sounded as tired and scared as Derek felt. Devoid of the energy or the anger to say anything biting he simply shook his head.

"Bailey said she was protecting her patient. That's so like her--worry about her pregnant patient and not her own pregnant self."

Nodding, Mark moved to sit at the opposite end of the bench. "One time maybe it would've been better if she was more selfish... like us."

Derek smiled slightly, imaging how much Addison would hate that comment.
But the slight upturn left his lips quickly.

"You knew, I guess, before today?"

"She didn't tell me either. More like I figured it out," Mark replied. "She's been doing well, though, taking good care of herself. She is positively in love with that baby."

That didn't surprise Derek at all. Though it had never become an obsessive point for them, Addison had always wanted a child.

"Derek, I, uh, I need to say something to you, okay? And I need you to hear me as the guy you used to think of as your friend, not as the guy you hate for falling in love with your wife. Because no matter what you think, we both care about her. We still have that in common."

It would have been so easy to say no and get up and walk away, but every thought he'd been mulling over the last 24 hours told Derek that doing what was easy had not served him well. And so much as the thought of listening to anything Mark had to say about Addison made him ill, he sat still and nodded his agreement.

"She was afraid you'd stay with her just for the baby. That's the main reason she didn't tell you. She felt like you all deserved better than that. But she's, uh, she's also worried that you won't want the baby. And she's gonna probably kill me for telling you this, and I guess really I shouldn't for my own reasons, too. I should want you to do something assy right now. But you... you need to be sure about what you want, what you feel, about the baby before you say anything to her. Because if you don't want to be that little girl's father... once you say that to her, you can't take it back, Derek."

It was almost impossible to believe that he was sitting here having this conversation with Mark Sloan, of all people. But Derek knew that he was right. Just as his own internal debate had told him that whatever choice he made about his romantic relationships needed to be definite and final in the weeks to come, this new decision, too, warranted that same absolute certainty. Addison would demand it, and rightly so.

They sat there silently in the midst of an uneasy and no doubt temporary truce. Then Derek stood and excused himself, making his way to Addison's room. His heart sank at the sight of her still laying there motionless. Miranda Bailey looked up from the chart she was writing in and then came toward him.

"She's holding steady. They both are. I'll check back in a little bit."

Derek thanked Bailey and after she left, he moved toward the far side of the bed. He sank down into the chair that rested there and looked at Addison, wondering what was going on inside her head. Was she worried about the baby? Was she afraid for herself? Was she scaring herself with thoughts of how he'd react to finding out the truth?

His eyes drifted to the monitor next to him and the readout that attested to the strength and regularity of the baby's heartbeat. The baby... he still couldn't believe it. He imagined Addison had spent hours thinking that exact same thought. A baby... now... after everything.

[i]"Since when is it not working? You've seemed so much happier. We've been so much happier."

"I didn't... I wanted it to work. I tried to act like it was working--"

"You 'tried to act like it was working'? My God, Derek, what... what the hell have you done to us?"[/i]

Derek sighed, their conversation from that last night in the trailer echoing in his head. The meaning in her question seemed so much more pointed now, and it made him feel ten times the guilt he'd felt then to know that she had been devastated not just for herself but for their child.

Leaning forward, Derek turned up the volume on the monitor and allowed the pounding of the baby's heart to sound in the room.

What the hell [i]had[/i] he done? And how was he going to make this right?

*****

Her head hurt. It was sore and she felt pounding and sharp pain, but Addison was relieved that she was feeling anything. Her eyes opened then slammed shut as the light overhead proved too much for her. Then she heard a familiar voice.

"It's about time you woke your lazy butt up."

Addison smiled as Richard took hold of her hand and when she opened her eyes again, she did so slowly, blinking till she felt comfortable.

"The baby's fine, Addie. And so are you. You had us worried for a while, but Derek said we should give you time to bounce back on your own, and you did."

At the mention of her unborn child, Addison's free hand had moved to her stomach, pressing flat against it. Hearing the name of the little girl's father made the redhead sigh.

"He knows then."

Richard nodded. "You could've told me, you know. I would've understood."

"I wanted to," she said, squeezing his hand, "but I didn't want to ask you to lie to Derek."

A small smile tugged at Richard's mouth and he leaned down and placed a gentle kiss against her forehead.

"You don't worry about any of that right now, okay? You just rest. And take advantage of the quiet in here while you can. I finally had to make Bailey chase Derek and Sloan away to get some sleep, and Stevens has spent more time in here than in the on call room."

Addison went to nod, but her head rebelled at the idea of moving, and when she squeezed her eyes closed, Richard laid her hand back down beside her on the bed.

"It's time for you and little one to rest. Everything will wait until you're 100% again. You just focus on getting well."

His last words barely reached her as Addison drifted back to sleep, but she let herself go without a fight, safe in the knowledge that she and her baby would be okay. Richard was right. Everything else could wait.

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