Wednesday, September 19, 2012

The rise and rise of unethical behaviour

This is actually a post about real life, which has some cross over into Azeroth.  What I actually wanted to talk about was...professional ethics.


I am one of those fortunate people that really loves what I do.  I love going to work, I love the work that I do, and if I find I'm not enjoying it, I don't do it.  People wonder, how can you love putting people to sleep all day long?  Is that even a job?  People can go to sleep by themselves! Surely anyone can do anaesthesia!?


Anaesthesia is a science, which dabbles in a bit of art.  If you think anyone can put someone to sleep, think again.  Look at what happened to Michael Jackson.  Even though his physician was a medical practitioner, he obviously didn't have the skills to look after an anaesthetised person.  Being an anaesthetist is a bit like being a pilot - it's the take off and landing which can be sketchy but usually the bits in between are smooth sailing.  That's why I have so much time to blog.

I think one of the great things about enjoying what you do, is that money is no object.  If it's interesting enough, you even do it for free.  I am no saint that works for free, but I definitely would not complain about  my income.  It's more than enough to keep in a lifestyle that suits my needs.  And I do charge my patients, so it's not like I'm working for peanuts.  But what is reasonable and what is unreasonable to charge, is what I have a bee in my bonnet about.

I have noticed increasingly that money makes the world go around.  In medicine, money is the root of all evil.  I have seen colleagues fighting over cases which give more money, seeing people chatting up and brown-nosing the surgeons so they can do their private work.  I see people whinging about others who get more private work, when really, it's none of anyone's business who is working with whom.  I see people having operations done by surgeons because they are privately insured or workers compensation (which means it pays a lot of money).  It makes me sad, because I feel that medical ethics has gone down the drain.  Operating on someone because you would get paid more for it? If the patient was public you would treat them conservatively, and not operate on them.  To me, that is unethical.

The other unethical behaviour I came across was lying.  In medicine, like anything else, mistakes are made.  You should own up to your mistakes.  I certainly own up to mine.  I've had complications from procedures, but these complications are an accepted part of that procedure.  I learn from those mistakes, I'm mortified by them, but I don't cover them up.  Being honest in our profession, I believe is very important.  It's when patients are LIED to, that's when they get angry.  And when I get lied to, I get angry.  If my junior training doctor lies to me about something (like they say they ordered a test but they didn't, or they did something dangerous then denied it) then they get a long tongue lashing from me about what is ethical behaviour.

The other day, one of the medical students was angry at one of my colleagues, another consultant, because he wouldn't let them attempt to do an injection of anaesthetic into the spinal cord.  Now this procedure has complications, and we usually only let our own training specialist registrars do these procedures, because they understand and respect the risks, and are willing to take on the responsibility of the complications.  It felt to me like even the medical students look at patients like pieces of meat to be played with, rather than people, and don't mind that their actions can have complications and consequences because it's all for their learning.  It made me upset, and I thought about how I need to educate these future doctors about ethics, empathy and treating people how you would like to be treated yourself.  That student was probably not the norm, as I often meet great medical students who would be great doctors, but I worry that this sort of attitude would be on the rise.  Students should be respectful to their elders, and not show their tempers like that anyway!  Hmph!

In medicine, medical fees are usually derived on what the medical practitioner thinks they are worth.  Each of us sets our fee structure to what we think we deserve to be paid.  The Australian Competition and Consumer Commission does not allow us to have similar pricing to our colleagues - they say this is collusion.  In medicine, you get a referral from your local doctor to see your specialist and then you have your operation with them, and don't really go shopping around for the best price.  It's interesting to me, because in real life we go hunting around for the best price of things like cars, computers, even toothpaste, but you have to accept this decision that people make about your health. 

And the funniest thing I find - is that if the doctor is very expensive, then people assume they are very good.  This attitude confuses me most of all.  There are a few of my colleagues who are very good, and I think are worth the money you pay for.  The rest of them, are no better, or even worse, and less experienced, than myself.  And people like that give my profession a bad name.

My father had a procedure done some years ago that required an anaesthetic - that procedure is something I do very commonly in my professional practice.  When he told me how much it cost him, I was astonished.  Firstly, the surgeons I work with, for those procedures, if the patient is in a health fund, then there is no out of pocket fee, or "no gap".  My fee, is also no gap.  It's a simple procedure, and it pays quite well already for 20 minutes of work.  However, my father's fee was three times the price I am used to seeing, and the anaesthetist bill was also 3 times my own fee.  And my parents' reaction to that?  "Oh, he must be very good, he's a professor!"  Are you kidding??  You were ripped off!  I was so horrified by their bill that I insisted they come to my hospital to have their procedure done the next time, done by one of my friends and colleagues - and it cost them nothing out of pocket.  And they even had a better outcome than the expensive one.  Go figure.

And they are not the only ones like that.  People in Australia really do think that the more expensive you are, the better you are.  Which I find... bizarre.

But I am hoping this is not the norm.  I think that there are just as many good and reasonable people out there as there are unscrupulous ones, and I hope that all you good people out there who need operations and things get the good, honest ones, not the money gouging ones who charge you just because they can.

I have never been good at making money from my private work - my fees are lower than most of my colleagues, but I feel happy with what I am making.  I think other people look at everyone else and think "Hey, they're charging x$ more than me, I think I can go at least that much as well!" which is normal, right?  But I feel embarrassed charging big $$ - it makes me wonder, is it a self esteem thing?  Do I not think I am worth much?

But I honestly don't believe I undervalue myself.  I don't think I have a low self esteem - in fact, I know I don't.  I take pride in the fact that I enjoy my work, and that others recognise that I enjoy it and am good at it. So why am I talking about this at all?  Am I envious of my colleagues that make more money than I do?

I thought about that a bit.  I am not envious.  Because I could easily charge that much money as well and keep quiet about it and earn big $$.  The reason I am talking about this is because this my World of Warcraft blog, and it is highly unlikely any other medical professionals I work with read it.  Talking about money and prices is very hush hush and closed shop in medicine.  I have often wished the public knew how much prices varied for operations, depending on which part of the city you live, and whether that would shock people.

I'll use this as an example.  In the more affluent suburbs, an epidural, for labour pain can cost someone up to $2000.  That's with top cover health insurance and you might be out of pocket about $500-$600.  In the less affluent suburbs, the normal price is $500-$800.  And people might think that the doctors out in the affluent suburbs are better... but I know for a fact that they are no better than many of us who work in the less affluent suburbs.

Another example, which I found a bit abhorrent - a well known, famous surgeon saw a patient for a tumour.  His fee was $40k - which is a lot.  Other surgeons I know, good and reliable ones, would do it for one third of that price.  When the patient said they would think about it, and ask around the surgeon said "By all means, look around.  But if you get it done by someone else and get a complication, that leaves you incapacitated, remember, you could have had it done by me."

Now what is someone supposed to say to that?  Talk about twisting your arm.  And complications can still occur, no matter how great a surgeon you are!  I don't deny that person was a great surgeon - but I DO object to suggestions like that, the subtle hints to put fear into someone.  I was so outraged, but I can't say anything about it.  People can charge whatever they want.  It's fair trade.

So, how does this relate to World of Warcraft?

Something like this happened.  Ouchies.

One of my Frostwolves guildies fell and injured himself, and he was sent to one of the posh private hospitals with posh prices and I was worried that he would have to pay a ridiculous fee when he could have had the same operation done for a lot less in a different part of the city.  I think that prompted the money concern with price gouging in different parts of the city.  Fortunately his fee was reasonable - it was within the range of what I said was reasonable rather than $600 more.

The other way it relates... well, as I said, I am pretty hopeless at making money.  The only way I know how to make money for SURE, is to work for it.  In real life, that means putting in more hours, picking up on call - working for the lowest amount of pay per hour (though by no means feel sorry for me, because the pay per hour is very high).  And that, is just like doing dailies.  I make most of my money from doing dailies.


Maybe I should read Spazzer's Gold Guide!

I get embarrassed charging high prices for anything.  That includes things I sell at AH, and prices for enchants or crafted items.  And in real life, I'm like that too!  I look at the prices my colleagues charge and if it was me, I'd feel embarrassed!  I shouldn't be though, because if people are happy to pay for it then I should be glad (and I should charge that!), but I can't bring myself to do that, I feel... guilty?  I'm not even sure if that is the right word.

But I really object to price gouging.  I object to people taking advantage of others because they don't know any better.  I know the attitude of most people is "If I can get away with it and some idiot wants to pay that, then why not?" I don't like people putting things on the AH for a really ridiculous price in the hope that someone will accidentally click "buy now" and pay 100x more than what it was supposed to be as an accident.  I suppose it really isn't unethical, but it is taking advantage of other people's stupidity.  But should we be taking advantage of that?  Shouldn't we be helping and educating those people?

And don't get me wrong, if you can make money that way, then good for you!  I can't, because I really truly am hopeless at it.  I'd give everything away for cost if it was up to me :P  I'm just trying to explain my difficulties with making gold except for the only way I know how - to grind it.  So for those of you who wonder why I can't make money from the AH - now you know why.  Because I'm dumb at it!

Back to my original topic - how can I address this rise in unethical behaviour?  All I can do really, is educate, and lead by example.  Calling people out publicly doesn't work and it's just nasty and rude.  I don't think I can change a whole generation of junior doctors, but hopefully others will see the positive side of doing what I do, and follow suit.  Some people don't want to be helped.  Others are already good.  It's the ones in the middle of the road, on the path between good and bad, that I hope to be able to steer in the right direction.

Phew.  Thanks for reading the rant.  I think I've finished now.

28 comments:

  1. Very interesting post :)

    I can relate to that a fair bit, especially about getting embarrassed charging high prices for anything. I'd love to give it all away for free if I could, but I need that gold for repair bills, consumables, levelling alts, flight training, etc. - Doesn't make it easy.

    At times I wish I could master the Auction House and rake in hundreds of thousands of gold, but that would probably cost me my soul. Alright, that's a bit dramatic, but the general idea is still there. Honestly, if I could get rich, I'd most likely just give it all away - in fact that would most likely be the only reason I'd really consider figuring out how to. Ah well.

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    1. I am hopeless at share markets and AH and I also end up giving things away a lot, which is why I never seem to have much money in WoW.

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  2. Having so many doctors and medical issues in the family, it's easier to find out who to go to when the need arises. I don't miss my practicums but I still remember some of my training quite vividly.

    In terms of the game though, I prefer to respond with "tip me what you think is fair" when they ask how much. I do the same when I require a service from other people I don't know. Often they won't ask for a tip, but I'll pay them something, even if it's a modest one and they are always appreciative.

    I think we're similar in that respect, we don't strive to make money like others but may offer something in trade instead of gold.

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    1. I think it's lucky for lots of people who are in or are family of those in the profession because you actually tend to get better recommendations. I agree with the tip what you think is fair - I only object to them getting it for free but even 5g is enough to show some consideration. Free for friends and guildies of course though :)

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    2. And yes I am like you! Sometimes if people ask me how much for an enchant I ask what profession are you and if they say mining I ask for volatile earth as payment.

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  3. I had to come back to this after calming down or my comment would be longer than your post. My husband and I are hoping to die instantly in a car crash as we can't afford to actually have an illness.

    I'm afraid I'm the same. I have such a hard time charging for work. I really think if I tallied up the hours I charge for and the hours I do free, the free would be higher. I am hopeless. I do have a confession though. I have absolutely no problem charging doctors or lawyers for every single minute of work, they are the exception, lol.

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    1. It is rather scary in America, however in Australia health care is free, but if you want to have something done privately then it costs you (which means your choice of specialist, no students/registrars, and you get to have no wait on your surgery). However, I do believe that if you have free health care then you should let medical students put drips in or take blood so they can learn, but the riskier procedures should be done by training specialists so they can learn. It sounds terrible but that is the price of free health care, imo.

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  4. You hit two nails on the head there Navi..."money is the root of all evil" and your comments on unethical behavior. When it comes to money too many people out there willingly act unethical. Hell, all you have to do is watch any reality tv show to see that.

    I know the basis of your post revolves around the medical field, but this happens in ALL walks of life. And it's very sad. I blame society. To me, society as a whole is too consumed with being bigger and better than their neighbor. They must have more. And many could care less about how they obtain it. It is drilled into us that the more we have the better we are. The more money, cars, houses, clothes, electronics, etc. makes us happier by society's standards. And that's where the problem stems from. It's rare to find someone who is happy with what they have. And, heaven forbid, never say that you are "content" because in society's eyes that is not acceptable. As I see it society tells us we must always strive for bigger and better.

    Why? If I am happy, or you are happy, in the current state we live in why should we change it? Why put someone else's happiness at risk just so we can have bigger, better and more stuff?

    Now, about unethicality (word?), I feel that stems from bad parenting. If we are not taught that there are consequences from our actions then we are going to care less about what we do. (man I'm going to sound old saying this...but) Children now-a-days have very little grasp on that concept. It falls hand in hand with respect. They know very little about it and show it even less. (omg...I'm turning into my mother...lol) But seriously, if basic things like respect, not only for others but yourself as well, are not taught to you then you will not know what is ethical or not...or moral or not. All you have to do is look at the current state of WoW for that.

    Ok, I'm stepping down from my soap box now. My mind is spinning and my thoughts are getting jumbled. I risk this becoming a bunch of rambling nonsense if I don't stop now. I hope you get what I'm trying to say though.

    (maybe I should have done like Tome and stepped away and came back once my thoughts were gathered...lol)

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    1. I was a bit tunnelvisioned there Thel, because I was grumpy about medicine but you are right, it's everywhere. I was specifically talking about money here, but there are other things where ethics and respect are involved - you only have to look around at LFR, BGs, wow forums and you can see how people think it's ok to be disrespectful and rude when people are trying to help. Taking things from others when you don't need it. Bullying others. You see it in real life on the news, in the papers... and it's sad and I hope that I will be able to drill it into my own children otherwise I'll be one of those bad parents...

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  5. I don't think I pricegouge on the auction house. I most certainly do make a fair buck off it, and I would be a fool if I didn't admit people like me cause server inflation. But I'd like to think I offset that simply because if someone I know needs anything in-game, and I can get it for them, I will. And I will give it to them (so to speak...don't come asking me for a fleet of Mammoths...). Very very rarely will I give someone any gold, but I'll always help them out with gear, Enchants, gems, pets, whatever I can. It's because of how I play the auction house that I'm in a position to do that in the first place.

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    1. No no I'm not talking about the usual auction house player, I'm talking about those idiots who put say a stack of 5 volatile air for 100g bid and 10000 gold buyout - you know, an accidental click and you could accidentally pay 10000 gold for that stuff, which is clearly a ripoff! So I don't want anyone to think that I think anyone who plays the AH is terrible, what I'm trying to say that is there is a skill to it which I lack because I'm bad at measuring supply demand, but I object to AH gougers who take advantage of noobs in game just because they can.

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    2. This is not the bad one, because you can list by BO price (i sort my AH with iLvl then BO price) so if someone does a big price jump it will be obvious.

      The worst offender is actually selling things in stacks, for example embercloths, they flood the market with stacks of 20, but also put stacks of 2 or 1 with same starting Bid and BO, and it can catch out people buying in bulk. (and if they collect their AH mail in balk they may not even have noticed they got ripped).

      An even worse example is when you use to have to buy engineering crafted bullets/arrows... and the stack is 200...

      Then again, I have sold Ice cold milk on AH on certain event weeks for 10x price of the vendor in the next building to the AH... and man they DO sell... but not as much as what some people boasts.
      (I did it only to see if the rumour were true)

      KSret

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    3. LOL milk? Wow, some people must be REALLY LAZY if they can't be bothered going to an inn...

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  6. Very good post Navimie! I had no idea that is what you did for a living! I agree about the auction house sharks. These are also the people who will put up a vendor item (like a vendor pet) for hundreds of gold, simply because people don't know you can visit the vendor and buy it at any time. Now, don't get me wrong, people can only sell what people are willing to buy, but still, if I happen to pi ck up something like that I'll sell it for maybe a few gold over what it costs at the vendor.

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    1. I agree Eluna about taking advantage of the ignorant. I mean a few gold is ok but 100s or even 1000s of gold? I feel bad for those people.

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  7. Interesting

    Navi...
    Firstly you live in a country where price gourging is the NORM... Just went overseas to Germany, now I am struggling to buy anything back here at home...

    Secondly, price is determined by the buyer not the seller, unless the seller has a monopoly or forms a cartel.

    And I must admit I have had times where I actually clear the AH of certain raw materials and relist them at a profit :P but that was ages ago when 20k gold was quite a lot.

    ksret

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    1. Hey Ksret :) I'm not saying high prices are bad, the AH runs on supply demand and I understand that it's set by the buyer. I am only objecting to people trying to trick others on the AH by selling stuff for 1000g for example that you can buy from a vendor that is not limited supply because people don't know any better. I don't like those who take advantage of other's stupidity or ignorance :D

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    2. Btw Navi

      I once heard a rumour that most anaesthetis charge AMA rates, or was that for certain areas only...

      (BTW I am only bulk-billing at the moment >< my income will more than double if I charge AMA rates lol)

      KSret

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    3. No, we do not all charge AMA rates! It depends on the surgeon for me. If my surgeon wants me to charge a gap, I do. If they no gap, then I no gap. But I never charge AMA rates unless it's Worker's Comp which then is the expected fee.

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  8. Navi, you get crazy respect from me for not gouging. It just seems evil to price gouge people who are already in trouble. I'm all for making money but if money is someone's prime motivator, they're not going to be better than someone who does the work because they enjoy it and see the money as a perk.

    My wife is studying nursing and she goes around volunteering at hospices and in low income areas because she wants to do something for the underprivileged. (Then she turns around and racks up huge bills on my credit card... LOL!)

    As for in game, your price and sale volume are inversely proportional. If you list things with a lower markup, they'll sell more. If you list something at an exorbitant price it is much less likely to sell. Personally I am not a fan of unsold auctions so I'll list at a 10 - 20% margin on most stuff. Unless the mats are ridiculously cheap and it takes forever to mill/prospect them, then I'll aim for higher profits to recoup the time invested.

    But yes, pricing fairly helps everyone in the long run. Not everyone has the wisdom to see the long view though.


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    1. I'm just bad at selling things for a profit. Hats of to Mrs Thunder for volunteering - that's really noble! Thanks for the comment Thunder :)

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  9. I think sometimes when we love what we do we undervalue ourselves. I am not saying you are doing this. In my example though I do programming work and I wayyy undercharged for my services for years... and then I jacked my prices wayy up and I was still undercharging and still getting as much work as before. I just assumed since I was having fun I should not charge a decent wage.

    Your situation seems a little different as you are also concerned about gouging people for money for medical care.. which is very altruistic of you.

    As far as WoW goes.. I never consider the AH real life money.. so I do not mind being a bit of a goblin. On our server you can buy Warbot pets for 350g from the vendor and resell them for 4-6k. I have taken advantage of this. :). Perhaps I should feel bad. In real life I doubt I would ever gouge someone that much.. but items have intrinsic values.. so if I found like a rare comic book for ten cents does that mean I should resell it to a comic store for 20 cents? Or should I make the real value? Or even am I obligated to tell the person selling it that they can probably make a lot more money... ethics. yeacchh.

    I like your posts that give insight into your personality. You seem like a really cool person.



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    1. SirFWALGMan, you compliment me sir! LOL well I am very amused that people buy the Warbot pets not realising you can get them from Dalaran! I believe the real value of an item should be made, as that is based on demand and supply, so rare items of course are worth tons and tons! All I'm saying is I am bad at business :D I take too long and too much effort to do things that the $$ price I put on my effort is too much for the item, and I can't sell it - or the things that are worth heaps I have no idea and I sell it cheap!

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  10. Hey Navi,

    I'd have the same struggle in your situation. And it is a struggle, because you need to find a balance between respecting others (your customers/patients) and respecting yourself and your dependents. In the end, if you are happy with your income and your conscience is at ease about it, then you are doing exactly the right thing!
    I don't know whether your perception of these other practitioners who overcharge has got this far, but I'd find it very hard to have the knowledge you do and not look at them with distaste or even contempt. And bullying patients to keep them from shopping around is, as you say, abhorrent.
    You don't sound like you are a training specialist - perhaps one way of teaching your ethical code is to become a training specialist so you get to spend more time with these junior doctors.

    As for WoW AH.....oh, Navi. It really is ridiculously easy to set up a decent income from it. All you need to do is find something that will sell regularly, and get comfortable with that item. I specialised in enchanting rods to start with. (Until now grrrrrrr!) My enchanter only makes and sells about 6 different enchants, plus the pet. They don't sell very quickly but they are a good way of making some money on the side. The thing is, get enough niche items/industries going at once, and though you don't make much from any particular one, you find that suddenly you made 10k in 2 days. All for a few minutes work.

    The best thing is, if you specialise in a niche for long enough, you usually end up either controlling it or having very little competition, which means you can set the profit margin according to your personal ethics!

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    1. Oops, forgot to add: keep in mind that some of these apparent price gouging attempts you see are genuine mistakes on the part of the seller. Gods know I have listed single volatiles for hundreds of gold by mistake.....also, while there are some actual price gouge examples in the AH, the majority of the time it really isn't the case. The seller may list something at a grossly inflated rate, but the person buying is usually consciously making the decision to pay more gold rather than do whatever it is to get the item another way. In the real world, price gouging happens when the buyer has no choice but to pay that price. In WoW, it is usually the case that they *could* farm/craft it themselves.

      I guess my point is, it is usually not very easy to tell what is genuine price gouging in WoW....

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    2. Hey Dahahka, no I'm not a training specialist, I AM a specialist but I am in charge of the training specialists so it can be a bit confusing when I'm talking. The whole medical training thing is a bit confusing to people sometimes so I won't go into it here - maybe another time!
      I don't have the mindset for AH Dahakha, I think I prefer the solid known income I get from dailies. Part of that is because I don't have any gathering professions! Tailoring and Enchanting are my professions and selling stuff I make from them is through trade channel rather than AH.
      Maybe if I started my wow career as a herb/alchy then I might be thinking differently today.

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  11. I've been at a professional conference for the past few days. One of the classes I took was over ethics. If I remember correctly, we have a utilitarian theory and a kantian theory. The kantian theory was most intriguing. If I understood it right, we do things for the benefit of the other. From the other side, we do no harm.

    I think that a case could be made that over pricing things ultimately does harm to the community...placing people in debt, pricing people out of the market of life saving proceedures, etc.

    Anyway, I wish you the best in regards to your real life endeavors.

    Z

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