A Patient’s Perspective
by Elliot Haroldsen
© E R Haroldsen
While in recovery from viral encephalitis at the hospital, I observed things. At the time, I couldn’t record any of them, so this is completely from memory.
For this narrative, I’ll call the “first day” as the first day that I was back in the real world and I knew where I was. This started November 30th, 2015 and went through December 7th. The previous week is what I will call the “dream world”, starting November 22nd, 2015 and going through November 29.
Information is organized by topic.
My First Day and My Angel
My first day—I woke up, looking at the wall to the right. I rolled over and saw the status board, clock, TV and a pole with an IV bag hanging on it. I recognized them from my dream world but this time, I knew it was a hospital.
My daughter, Lisa, was in the chair to my left. She was awake. I wonder if she ever slept. She told me where I was and why and she guided me through the next few hours until my wife, BJ, arrived. Lisa had become my guardian angel.
Someone had selected my breakfast. The French toast was dry and tasteless to me. Lisa suggested the cream-o-wheat. I said, “I’d rather starve to death than eat cream-o-wheat.”
I didn’t know it at the time but my family was afraid the hospital was going to send me to a nursing home rather than keep me in rehabilitation. And my family didn’t think I would get as much therapy in that setting. For that reason, Lisa began rehearsing facts with me so that when asked, I could give a coherent answer. She wanted them to know that I was recovering.
Lisa: What day is it?
I didn’t know. I didn’t even know what month, season or year it was.
Lisa: “What is your birth date?” That was a very popular question. Everyone seemed to ask it.
EH: April fifteen, nineteen forty-eight.
Lisa: No. It’s nineteen forty-nine.
Why did I keep saying nineteen forty-eight? That didn’t make any sense. That was my parent’s marriage year, but for some reason, I seemed to be stuck on forty-eight.
Lisa: What’s my name?
EH: “Yourrrrrrrr Lisa.” My brain kept wanting to say Nicole. I don’t know why.
Lisa: What’s your wife’s name?
EH: “Brenda.” I never had a problem remembering her name, although at home I normally call her BJ.
Lisa: Where are you now?
EH: “Jefferson Hills Hospital.” No one ever objected to my getting it wrong. I guess the important part was that I knew I was in a hospital.
Lisa, or whichever family member was with me, would report to nurses that I was eating. I could walk. I could talk. When I used my walker, which they required, I would use it to help stand up, but I didn’t lean on it. I pushed it in front of me and lifted it to change directions.
Later, various staff members arrived. As Lisa predicted, they asked me questions to judge my competency. I could talk coherently but my thinking was muddled and answers often were wrong or I couldn’t remember them.
By the time BJ arrived, I had come to understand that I was not the man I used to be. I told her that I could not be trusted. She never liked me to say that, but I realized that I couldn’t rely on my memory, in the normal way.
The next day, she brought in my lap top computer and I showed her how to access our bank account info, our credit card accounts and my list of passwords.
I couldn’t write. It was hard to find a pen or pencil or any paper, since things had to be cleared away for my meal tray. When I did try to write, the pen didn’t go where I wanted it to go. The lettering was small and kept getting smaller. With my lap top computer, I couldn’t control my fingers enough to hit the intended key. Then I looked at what I had written and saw that it didn’t make sense. My mind was too muddled to determine what was wrong. I just couldn’t remember things and the hospital internet was not cooperative.
All of this was a slow, difficult and frustrating task. I was turning over this information to Brenda because I had no assurance that I’d ever be normal again. I had been handling our finances and paying our bills for years. Now it was her turn.
That evening, Lisa brought the kids so they could see me and play games on my bed. When Lisa suggested that I play games, I said, “I’d rather eat cream-o-wheat.” That’s when she decided I was really back.
The Illness: Viral Encephalitis
When I first arrived, the staff thought I had had a stroke. The symptoms seemed to match. However, testing said no. There should have been pain and fever. I had none. They considered it might be depression. A Doctor, a psychiatrist, rejected this idea. There were no signs of anxiety, agitation or any history of mental illness. He said they needed to wake me up, not to calm me down.
They did a lumbar puncture (spinal tap). They found abnormalities in the spinal fluid. While the results were not decisive, they concluded it had to be encephalitis. They began to treat me for it.
Encephalitis is an infection of the brain. It can be caused by a wide variety of things, including herpes simplex, Lyme disease, or bacterial meningitis. It can affect the brain in many different ways. In my case, it seemed to center on the Broca area of the brain, which is the center of speech. I was never at risk of dying but my brain was at severe risk of major and permanent damage. Since it was a virus, the only thing to do was to wait it out, treat the symptoms and see how much damage it had done to me.
The first three days in the hospital, I was in the R & C area where hospital staff tried to determine what was wrong with me. Later, I stayed ten days in the Rehabilitation area where the staff helped to make me functional. I remember nothing about the first area. I also remember nothing about all the procedures done to me. The two sections are run like two different hospitals. I had to be discharged from one before I could be admitted to the other.
I have mixed feelings about not remembering what happened. If it happened, I want to know about it. I once considered writing a story about a person in surgery who experiences the pain of every cut and then doesn’t remember it. Does not remembering something mean you never felt the pain? I don’t think so.
While in the dream world, I remember almost nothing about the daytime but the long night hours of laying in the bed in partial darkness was integrated into my dreams. There was a curtained window to my right. It seemed like I was in a garage, basement or underground room. It was actually the third floor. In the real world, during the day, when the curtains were open, I could see out onto a roof area. Beyond that, there were more floors with office like windows going up. When the weather was good, I could watch the sunlight moving down the opposite walls. I don’t remember the sun shining in my window at any time.
There was a privacy curtain to the left. At night, it was back lit by a dim incandescent light, making everything in the room a dull orange color. On the far side, to the left was a restroom with the door open and the light always on.
While in the dream world, I thought this restroom was actually a long hallway. Sometimes people came and went out of it. It felt like a science fiction movie with strange people, strange electronic equipment and strange purposes.
Sometimes, there was activity in or around my room. I had a roommate but there was a partial wall and curtain separating us. Later I learned he was called Rudy, short for Rudolf. He was a demanding patient and often called from the darkness for a nurse. I had very little interaction with him. For a couple of days a therapist worked with him on his home finances. He had been a businessman but now had a hard time with the numbers. He was discharged the same day as I, but he went to a nursing home. I assume he wasn’t progressing.
The thing that dominated me most during my time in the hospital was the wall—the one opposite me at the foot of the bed. It was always there and it was always a part of my dreams. I got very tired of looking at it.
A large clock hung to the upper left, a TV hung to the upper right. There were a number of posters and signs in the center.
Central to all of this was a large status board. At the time, it didn’t mean much to me. I was either too tired to care or too muddled to understand.
In the middle of the board was a series of smiley faces ranging from happy to sad. I was already familiar with this pain scale. Staff would ask: “On a scale of 1 to 10 with 10 being the worst pain you have ever experienced, how much pain are you experiencing right now?” I never said more than 2. Rudy usually said 8.
Looking back, I can see the board had good information about me. This example shows the date as 12/5, my evaluation date had been on Thurs 12/2, and my anticipated discharge date was 12/7. I was getting support from my SPOUSE/CHR (Spouse & Children). I needed assistance. I had to use a walker. My bed had an alarm and I had a high risk of falling.
There were other warning signs, plus my family had stuck up some of our family photos. That didn’t help much because of my fog and the distance between me and the wall. I could hardly see them.
There was one sign that I had seen in several locations. It had a hand and finger shaped to create an “O” and a printed “K” forming an “OK”. “It’s OK To Ask. Proper hand hygiene. It’s everyone’s responsibility.” While there, it didn’t make sense. Weeks later, it still didn’t make sense. Not that the message was wrong but their effort to be cute was irritating to me. Perhaps some artist didn’t have enough to do.
While in the dream world, I remember my son, Joe, sitting at a chair along that wall with his lap top computer, his face illuminated by the glow of the screen. I remember asking him where I was. I dreamt he said I was in a hospital with a rare disease. I was being prepared for a special church assignment and this was a joint activity between Pres. Murray, the high council and McKeesport hospital. I dreamt he opened a roll up garage door. I could see the ambulance inside and I recognized the street outside as the street on the south side of McKeesport hospital.
I wondered about this special assignment and about the team. Were they good guys or the bad guys. It was like some spy movie. In reality, none of it happened. None of it was true. None of it made any sense when I was lucid. (Except that Joe and Lisa took turns staying through the nights with me. And Joe always stayed awake and used his computer a lot.)
Lisa remembers that I asked her where I was. She said in the hospital and that I had viral encephalitis. “That’s very interesting,” I said. “How is your mother taking this?”
While in the dream world, I saw the great cosmos. It was kind of a blob-like thing, fat in the center and pointed on each end, like a piece of ravioli. It included everything in its matrix—every galaxy, every quasar, every electron, every subatomic particle, every movement I made, every breath I took, everything from the beginning of eternity to the end of time and in the exact center of this thing was this wall. Apparently, the status board was the all controlling force of everything. It was the answer to the great question about “Life, the Universe and Everything.”
The television was of limited value. It had the quality but the controls only allowed me to move up or down the channels one step at a time. I didn’t know anything about the channels or schedules. My mind couldn’t concentrate on any particular plot. There were advertisements for some interesting programs but I couldn’t remember the schedule or keep track of the time. I couldn’t keep track of which channels were interesting. It is sad when your brain is not capable of understanding low quality programing.
Sometimes, the advertisement seemed to suck me in and would not let me out. I’m still wondering about one. It started with a big banner, canary yellow with Delox written on it. The sign didn’t confine itself to the TV. It covered the wall. I have since tried to look up Delox and have found nothing comparable on the internet.
Perhaps my mind took the images and integrated them into a dream world scenario. Once while BJ was sitting next to me, I pointed to an advertisement and said, “That advertisement will do things to you.” We watched. Nothing unusual happened.
The division between the dream world and the real world was fuzzy.
Visions and Illusions
The dream world and the real world sometimes overlapped. I could remember many of the dreams and sometimes I wasn’t sure if what I remembered had happened in some form. I asked Joe and Lisa about some of them, to learn what had really happened. Were they really running a virus network to fight against evil? No.
The first day in the real world, I could see things that I knew didn’t exist. I could see what I called zingers. They were little shapes, mostly transparent, perhaps an inch across at ten feet. They would fly across my field of vision just fast enough that I couldn’t actually look at them, like really fast spiders on the wall. I saw lines on the floor that could have been there to guide a person around the hospital. On closer examination, they weren’t there. The floor tile was multicolored with little streaks of color. I thought these streaks said “erharoldsen” in blue or red lettering about an eighth of an inch tall. If I got down closer to the floor, the lettering disappeared and they were just color streaks. When I moved away, they reappeared. This only lasted the first day.
I had noticed this phenomenon before. As a teen, I worked with my brothers, sisters and cousins in the sugar beet fields of our grandfather’s farm in Idaho, walking up and down the rows and cutting out weeds. As the evening descended, the light diminished and at some point, the eyes switch from color to black and white. At that middle zone, the mind would pick from the broken soil shapes and identify it as the same shape of a weed. Then it colored that shape green. Where we were standing, the weeds at our feet were small but when we looked further down the row, they got taller and bigger. Get down close and look and the weeds disappeared. Stand up and they reappeared. We all could see them. That’s when we knew it was time to quit for the day.
All of the nurses and therapists were very nice to me. They were helpful and friendly. For a while, I thought it was because of my sparkling personality. Then I remembered that this was their job and they were paid to do this. They all told me their names but I don’t remember any except for Jill. I’m very talented at forgetting names. I made it a point to thank them warmly for anything they did. I was sure they saw many nasty and ugly things and I wanted to lessen it.
Jill was my primary physical therapist and had the most interaction with me. She was there through both weeks, so knew me in my dream world phase.
I asked Jill and others what I had done during the dream world phase. Everyone said I mostly slept a lot, ate almost nothing and couldn’t respond to anyone. Jill was one of the people who evaluated my progress and recommended to the committee my final discharge.
Since I can’t remember all these names, I shall refer to them by their positions. During the second week, I had several hours of therapy per day, morning and afternoon, plus all the other routine stuff. They would show up all cheerful, ready to do something with me. They knew their schedule. I rarely did, even though it was on the status board.
PT, OT, ST Therapy Definitions
The PT, physical therapy, concerned things below the waist—legs, coordination, walking, sitting up, bending over, movement, and stairways. The OT, occupational therapy, was concerned with things above the waist—arms, coordination, fingers, dexterity, how to do things required in everyday life. They had to know or train the patient on what to do for living at home. I would emphasize to them that at home, I had a good support system. ST, speech therapy was concerned about more than just speech. It concerned the ability to think, communicate ideas, and remember things … as well as the ability to swallow and eat. The muscles needed to swallow and to talk are closely connected.
The Daily Schedule
During the 2nd week, I never slept well, so they didn’t have to wake me in the morning. Quality sleep is something I haven’t had in many years.
Many of the medical staff would push around some type of black cart. It had a base of about two feet by two feet with four wheels. The middle structure was a Z shaped metal frame. I believe that was so they could change the height. On the top surface, they had various pieces of equipment which included a hand held bar code scanner like in the grocery stores, a computer keyboard and a screen, plus whatever equipment they needed to do their job. It was a “COW”, which stood for “Computer On Wheels”, though they refrained from using the term around patients.
Generally, in the morning, a person came pushing a COW. He’d scan the barcode on the ID bracelet on my wrist, take my blood pressure, pulse and temperature and then enter the info into a computer.
Later, another person would come with a COW. He’d cheerfully announce that he was here for a blood sample. He’d put the elastic band around my upper arm, insert the needle and take the blood, bandage the insertion point and be gone. These vampires were very skilled. I never had one fail on the first try. The nurses didn’t do so well. Several had trouble inserting an IV, one even going for help from another nurse. Blood samples were taken from inside the elbow. The IV was inserted in the forearm. Probably that was more difficult.
An elderly German woman came, pushing a cart loaded with food trays. Her voice, accent and even her conformation reminded me of Torte Combs from NRF. She brought breakfast, based on the previous day’s request. She’d put it on the tray table. Later she returned with a computer pad and reviewed the menu options for lunch and dinner. Later still, she would bring the lunch and then dinner. There always seemed to be more food that I needed. On my last day, she brought me a farewell cookie.
During the day, therapists would pop in. The ST would pull up a chair and talk to me. PT and OT would wheel me to one of several large rooms with special equipment.
In the evening, a nurse would guide a COW into my room and count out my allotment of pills and give them to me in a small plastic cup. Next came an anti-nausea injection into the lower abdomen. I’d pull up my shirt and they would stick me. I’d lay there thinking that I can’t believe I’m letting people do this to me.
The injections made my belly look bruised, black and blue, especially after two weeks. I was home for several weeks before the color went away.
Sometimes a doctor would show up, ask a few questions and leave. I couldn’t keep track of them. I left that job to BJ and Lisa, who kept notes of what they learned. That’s why I know of all the things they did during the first three days, even though I remember none of it.
Physical Therapy Room
The Physical Therapy room was large, open and had windows. There was nothing worth looking at outside. There were various simple exercise machines around the outside and some in the middle. This place was nothing like an exercise gym. Gyms are full of machines. This was open. One wall was decorated with Pittsburgh Steelers stuff, mostly team jerseys. I suppose the uniform numbers had significance but they meant nothing to me. I did recognize the room from the dream world when Lisa had taken me there. In the dream, Lisa was being inducted into an elite group of Pittsburgh Steeler fans. This was their meeting place and she wanted me to see the ceremony. (In fact, the Tatlows are Steeler fans but not to the extent for such special treatment.)
There were patients parked in their wheelchairs around the edge of the room. I joined them. The therapists were careful not to over exert people. After doing some task, I was given time to rest while they helped another patient, updated my chart or did other things. Some of these patients must have been there for a significant time because they chatted with each other like old friends.
I’m told that one time while in the dream world, Lisa and I were in the PT room and I said I wanted a drink of water. In an effort to get me to actually do something, she said the water was across the room and if I wanted it, I had to go get it. I got up and with my walker, made the trip across the room and returned. This was a victory on her part.
Once day as we were leaving, I saw a woman named Bernadette. She was middle aged, sitting in a wheelchair, limp hair and obviously in severe pain. I was told they had to use a lift to get her into the chair. I wanted to cry for her. Days later, I saw her again and I was so glad to see she was feeling better.
When there, sometimes I’d work a leg exerciser. I didn’t even have to leave the wheel chair. Sometimes, we practiced walking around the room or up and down the hall with Jill holding my arm lest I fall.
In one corner, there was a set of wooden stairs with four steps, a platform and handrails. I would carefully go up them, turn and walk down. Jill stood by to catch me if I slipped. Later, I did this with a cane. The cane was very useful, so they decided it would become my constant companion. Six weeks later, at home, I was still using it when descending the stairs.
I saw a very elderly woman on the stairs with three therapists crowded around her, trying to help her get down. She was making chirping sounds like a bird and crying, “I’m scared.” She was terrified. I wanted to go over and pick her up but the therapists were in control and I was much too weak for such heroics.
In the hall outside the room, was a long wood handrail. I held on to it and side stepped along it. Then I side step back. Then Jill had me do offset steps. Right foot step right, left foot behind right, right foot back, or something like that. I did terrible. “Why is this so difficult?” I said out of frustration.
“Because it is something you don’t normally do.”
Occupational Therapy Room
This room had more domestic things. There was the mockup of a car, a bed room, a kitchen, a bathroom and some exercise equipment. I used a pedal machine for my hands. They had me open the door to the car, climb in, and close the door. Then I got out.
When given an assignment, I would carefully study the situation, make a plan and then act. That’s what they wanted me to do. That was the test.
(It reminded me of some of the things we did at Bettis Atomic Power Laboratory. I was once asked to open a new large trash container on wheels. In this case, I wasn’t being tested. It was the equipment that was being tested. The engineers wanted to know if a person who was totally unfamiliar with a piece of hardware could use it correctly. I was able to open it and close it without smashing a thumb or cutting off a finger.)
I was told to sit on a toilet. I looked, lifted the lid, turned, backed up to it and sat. The test was to see if I looked behind before sitting. I was given a pair of cut off pants and told to put them on over my gym pants and pull them up to my knees. They were ragged with strings hanging off. I untangled them and slid them on. The test was to see if I untangled the strings.
On my first day of reality, I was given a peg board and told to recreate a geometric pattern. It was very difficult. I couldn’t make my fingers work. The pegs didn’t want to go into the holes.
I was given a piece of paper. The therapist wrote three words down the left and I was supposed to write a sentence using each word, simple words like ‘cat’ or ‘box’. I was a professional writer and I wanted to do something really clever. It was a disaster. This was my first day of being coherent and I was still learning about my limited abilities. I think I had an arrogant attitude about that task and it worked against me.
I was given a paper with some simple geometric shapes and asked to draw boxes between them. My boxes didn’t connect. My hand had its own opinion of what it wanted to do.
A week later, I was given the writing exercise again. The first word was “winter”. I wrote something like: “Winter came with all the kindness of a hyena with boils.” I had told them I was a professional writer.
Fear of Falling
There was a fear of my falling—not from me. I thought I could do anything. It wasn’t my fault that the floors kept tilting. The hospital staff were terrified that I’d hurt myself. They made me sleep with rubber soled socks or slippers for when I got out of bed. Later, that phobia extended to the therapists who visited me at home. BJ made me stay on the main floor of our home, sleeping in one of the guest rooms, until the Higgins family arrived on Dec 23 for their vacation visit. Then I moved downstairs to our bedroom and I used the cane to get up and down the stairs. (The therapists had been working with me on going up & down the stairs, and thought it was safe for me.)This seemed excessively restrictive but I trusted their opinion on the subject.
To keep me confined in the hospital, there was an alarm build into the chair and the bed. If I stood up, the alarm would sound and I’d sit down. I had to get a nurse to assist me to move between chair and bed. The restroom was 12 feet away but I had to get a nurse, use a walker and often I dragged along a pole stand with an IV bottle hanging from it. I often thought that a person in jail had more freedom than I had. However, I wasn’t concerned about it. I took it on faith that there were reasons for the limitations.
When going to therapy, I traveled by wheel chair except for once on the last day. That time, Jill held on to me while I walked back to my room with my cane. That caused a small disturbance. Others in the PT room noticed my wheel chair and chart was there but I was gone. They immediately went to my room and found me with Jill. Problem corrected.
I never did fall but it was quickly obvious that I definitely was unstable, so I deferred to their professional requirements. When finally at home, there were moments when I would be descending our stairs that the step I was about to step on seemed to shift and I had to clench the guard rail in a brief panic. That happened through my next 6 weeks at home.
Speech Therapy (ST) would come by about once a day and we had very interesting discussions. She was evaluating me but she was also stimulating my thinking. I really enjoyed these meetings. It helped my mind and gave it exercise. When she asked a question, I often tried to answer it correctly but in an unexpected way. She started to request a “normal” answer to her questions.
ST: When you take a bath, do you dry off before or after you get out?
EH: I do both. I dry off the top of me, then step out and finish the job.
ST: Do banana have seeds?
EH: Yes, they do.
ST: Do they really?
EH: Yes. They definitely have seeds. Those little black spots around the center, those are seeds.
ST: Do apples have seeds?
ST: Who is the President?
EH: “Monson.” (Monson is the president of the LDS church, so the answer was correct, especially to me, a Bishop in the church.)
ST: Who is the President?
EH: Oh, yes. That other guy. Ahhh, Obama. I have a rather poor opinion of him.
ST: So do I.
ST would read off a series of numbers and then ask me to repeat them back. A normal person can remember seven digits. I can remember three. I told her that this limitation was not new. I’ve always had a problem with four digit and larger numbers, like phone numbers, radio frequencies and call signs. My sister, Jana, can only remember two digits and she is one smart girl.
ST told me three words and said me she would ask for those three words later. When she did, I could only remember two of them.
ST: Do you associate salt with the color green?
ST: Salt and green?
I explained to her what salt does to copper wire and that it turns it green. Green and salt are closely connected in my mind. Think of the Statue of Liberty and all that salt water. It would have been different if she had said red, blue, yellow or anything except green.
The first day, she gave me a score of 5. On our last meeting, she gave me a score of 25. I don’t know what the top score could have been.
I had to be escorted to the toilet. When done, I had to pull an alarm cord and be escorted to my bed or chair while using my walker and pulling my IV pole. I had to do this several times during the night and during the day. On the first day, the nurse went with me into the restroom and was ready to help with everything. She quickly saw that I could take care of things on my own. Soon they were content to get me to the room and back. All they did was reset the alarm.
I had to completely wash or to be washed each day. The first time I knew anything about it, a nurse came with a small tub of warm sudsy water, some wash cloths and towels. Standing in my room, she would wash me, section by section, hair, front, back, down below—everywhere. Then she helped me dress. I had no concern about my dignity. I had lost that to medical people years ago.
As the days progressed, I was given greater freedom to do my own ablutions. On the last day, Jill offered a shower—a real shower. The room had four shower stalls, each with two sections—one wet, the other dry. She didn’t come in to assist but she was close and did assist in scrubbing my back.
Joe kept me shaved with my electric razor. I only remember this happening once but he had to have done it several times.
When I woke on that first Monday, my partial plate was in place. I have no idea how long I had been wearing it. I was told the nurses are experienced in taking care of things like that.
I was offered assistance to put on my CPAP mask. I refused. I am very skilled at doing this, even in total darkness.
I wonder what they did when I was in the dream world.
I was under continuous evaluation during the whole two weeks, first to find what was wrong and then to monitor my rehabilitation.
The staff was obviously talking among themselves about me. Once, during the morning wash up, a woman offered me a cheap plastic comb. I took it, looked at it thoughtfully and said, “What did the bald guy say to the comb? I’ll never part with you.” That was the joke. It was most effective because I am bald. The next day, I had another woman for the job. With a very silly grin, she held up a cheap plastic comb and waited. I knew what was required. “I will never part with this comb.” She was satisfied.
Lisa did all she could to ensure the hospital staff knew of my progress. In turn, I told them of the great support I would have at home.
The staff did a review on Thursday, my 11th day, about whether to discharge me. Jill had already hinted that she was going to recommend a discharge. She took me to the PT room. Lisa and BJ came along. Jill went to the staff meeting. Then BJ and Lisa were invited to join. Jill came back and said it looked like I would be discharged on Monday. I was slightly disappointed. I had hoped for Friday. Then BJ & Lisa came back and told me I’d be discharged on Monday. Jill felt guilty for having already given me the good news. We didn’t care. I was going home on Monday afternoon, after some therapy in the morning.
While writing this account, it became apparent that my skills are not back to where I want them to be. I use the wrong words. My tense is often wrong. I leave words out or leave off the endings. Sometimes, I think I should wait until I’m more capable but I also think that this writing is necessary to develop my abilities. My brain is still healing. Maybe like reformatting a computer, my brain will become better than it was before all of this happened. Wouldn’t that be fortuitous?
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