Chapter 1 "The Beginning Is Always The Hardest Part"

This is how my mother wanted to be remembered. My memory of her is a little bit different. I'm sure everyone remembers their own version of her. Versions I wouldn't even recognize. It's all that's really left of someone when they're gone. But that's the tricky thing. Nobody's memory is perfect or complete. We jumble things up. We lose track of time. We are in one place and another. And it all feels like one long, inescapable moment. It's just like my mother used to say: The carousel never stops turning. They say we can repress our memories. I wonder if we're just keeping them safe somewhere. Because no matter how painful they are, they are our most valuable possessions. Our lives are built on our mistakes as much as our successes. They made us who we are. Meredith Grey and Ellis Grey; Only Mama Knows

"Grey, you go home." Her superior called her name. Ellis looked up in surprise as Dr. Jensen told her to go home. "You're done for this day." "But ..." Ellis started to protest almost immediately. "Don't even get me started, Grey. You do exactly as I say. You should have stayed home weeks ago." Her superior was annoyed at her. Ellis Grey rolled her eyes but didn't reply. Except: "Yes, sir." "Glad you can follow orders ..." He replied ironically. Her fellow residents were looking at her condescending and patronizing. As if she wasn't fit to do her job. But they were wrong. Ellis Grey didn't know what to reply. Why are they thinking about sending her home? Ok, she was due in almost three weeks and any other woman would have stopped working a long time ago. But this was Ellis we're talking about.

She was going going to work until she couldn't anymore.

But right now, she was so tired. Her baby had been kicking her a lot.

Normally, she would have liked it but when it was interfering with her being able to work, she didn't know if it was that good. Today, she was forced to leave the operating room room due to the fact that she hasn't been able to concentrate with her baby using her bladder as a punching ball.

She sighed as she switched from her scrubs into normal street clothes. "Ellis?"

When she heard a man's voice, she looked up only to see Richard Webber standing there. "You're going home?" He asked, his brows her knitting in concern. Ellis huffed, she still thought that they're being ridiculous with sending her home. If she was going to have a medical emergency concerning her baby she'd be much safer in the hospital than at home.

Of course she'd done her research.

Placenta previa.

... and all other kinds of scary things that might neccessitate a Cesearian section. Ellis knew the odds.

Even though she was general surgeon or at least going to be a general surgeon. She was good, she had the talent and she was a woman. She was someone of her generation. She was going to be great.

She knew it.

But right now she was just tired and wanted nothing more than to lay down in an on-call room. But instead she had to go home.

"Ellis?" The voice repeated. "Yeah?"

She turned around, only to see Richard standing there, a creepy smile on his face. "What are you doing here?" Ellis asked. "Not that I'm not happy to see you but why are you here? Isn't Grahams letting you scrub in on his surgery? What are you doing here, passing up that amazing opportunity?"

"I just ... wanted to see how you're doing." He stammered. "I'm pregnant, not sick. There is a difference." Ellis answered annoyed. "I know, I just ..." "Well, I'm sick of people babying me." She complained as she was standing there shirtless not caring if Webber saw her like that. "You're almost three weeks away from your due date. You've gotta take it easy." He cared about her. But he also loved Adele. But he also had feelings for Ellis. God, love really was complicated.

God, why is this so tiring and exhausting?

Surgery was the one thing Ellis really lived for. And for the tiny human she was currently growing. She groaned suppressed. She'd wanted to stay at the hospital but the Chief insisted that she was going on. Her feet were aching and she had been suffering from Braxton Hicks all day. She even considered going to OB to get checked out. Ellis Grey was very tired. The doctor had recommended that she should do shorter hours at work and maybe he was right and she should really listen to him. After all, this was her child they were talking about.

Richard was hovering.

Although she did shorter hours than a normal resident. Then again, she was a woman and she was pregnant.

When Richard was paged she got into her car and drove back to her home.

In the night, she awakened when a sharp pain ripped through her abdomen. Her first thought was damn it, it's too early for her to come. Now is not the time. But when she started timing her contractions she counted that they were coming every fifteen minutes. Maybe it'd be safer to go to a hospital than to stay. Who knows what could happen?

No one.

Absolutely no one.

"Yes, hospital." She mumbled quietly as she grabbed her old phone and with shaky fingers, she called 911. She knew she wouldn't be able to drive a car and didn't want to get into an accident. After some minutes, minutes that seemed like an eternity, the ambulance was there. "Finally." Ellis mumbled as they were on their way to the hospital. She had no idea what would happen in the next few that but it wasn't good.

"Dr. Grey." The nurse, Lydia, greeted her. "The doctor will be shortly with you." Ellis never replied anything coherent. She looked up when Dr. Mahiss entered the exam room. The ultrasound machine was already there, on stand-by. She wasn't giving birth today and especially not at Seattle Grace. She was now at Seattle Presbyterian. She'd told the EMTs to bring her there and not to Seattle Grace. "Let's see what we've got. So, you're in labor?" She asked. Ellis grimaced before replying: "Yeah, pretty sure I am." Right on schedule, another wave ripped through her and she groaned loudly.

"Where's the father of the baby?"

"He left us."

She was now talking about the fetus and herself. "Ok." She knew the doctor was judging but she was too exhausted to care. "Let's just take a peek, ok? You've done the prenatal testing for genetic diseases like Down's or DiGeorge?" Ellis nodded in reply, as the doctor turned on the ultrasound machine and reached for the transducer.

"Of course." She hasn't taken any chances and for now, her pregnancy had been without any mentionable events that have happened. That's when the baby showed up on the screen of the monitor.

Ellis was once again fascinated.

"Hey, little one." She whispered as she looked at the monitor screen. She was looking at her baby girl.

That didn't happen often but in cases like this ... she could get emotional.

They tried to stop it but it wouldn't work. So it seems like Ellis was giving birth today. And not in three weeks as in anticipated. "Ok, I want to monitor your labor so I'm going to do this." As she explained Ellis didn't really listen. She couldn't have the baby now, could she?

"Dr. Grey are you listening?" The doctor asked.

"Uhm, what?"

"I'll take that as a no. We will use external monitoring to monitor the fetal heartbeat and the progression of the labor." Ellis nodded as they wrapped a pair of belts around her abdomen. One belt uses Doppler to detect the fetal heart rate. The other belt measures the length of contractions and the time between them. Ellis knew that.

She also knew that she had to stay in bed. But she could move and find a comfortable position.

Hours later:

The labor was progressing very slowly. It was exhaustive. Richard was with her, when he had the time in between doing doctor things. He'd taken some time off when he heard that she was about to give birth. Ellis was glad for him being there, especially since Thatcher had left after she told him. He'd said that she was married to her work and that he didn't want to live like that. Always wondering when she would be home from surgery. And so he left. Ellis had never heard anything from him and honestly she didn't care.

He wasn't there when she went to her OB to find out her baby's gender. He wasn't there.

She was alone and scared. He'd left her.

Ellis didn't want to think about and just as that, another contraction was coming. She grunted in pain and gripped Richard's hand tightly. But then he was called away. "I'm sorry but they're paging me. I've gotta go." "Don't you dare leaving ..." She screeched, breathing heavily. In and out an in and out. "You're doing great." Her OB told her to interrupt her. "Yeah? Doesn't really feel that way." She mumbled as another contraction was ripping her apart. The contraction were coming closer apart. Now they were coming every few minutes. "Ok, now push." And Ellis did. It was hard and painful but she did it. Although he had no idea how she did it.

When she was finally crowning, she was relieved. Her OB told her: "Don't push, the baby's head is crowning. Just give it a second." Oh, damn it. She wanted Richard, she fell back against the cushions and closed her eyes.

"Now, push." She advised her.

"Can't." It was just too painful. "I can't." She breathed. "It's too much. I want a c-section."

"You can do this, Dr. Grey. Just give me one last push."

In that moment, the fetal heart monitor was giving an alarm. "Damn it. Grey, your daughter's heartbeat has slowed down considerately. You have to push."

She grunted.

"Are you breathing? You have to breathe." The doctor said alarmed. "Don't tell me when to breathe. I breathe when I want to breathe." Ellis stared at him icily.

Come on, Ellis, do it. For your little, innocent girl who is your daughter.

And finally she started listening to what her doctor said. "I want you to push when the next contraction comes." Ellis felt beads of sweat forming on her forehead and she was exhausted. She wanted to sleep. She was thirsty even though she got fluids intravenously. She had no idea if she could do it again. But then, finally her daughter was out. She was tired, achy and she couldn't do anything. She couldn't push anymore ... then she remembered that her daughter was already born.

But there was no cry ... Immediately, commotion set off.

Meredith was born at a very sunny day which was a rarity in Seattle.

"Is she healthy?" Ellis asked, panic creeping up in her. "Why isn't she crying?"

"She's premature, Dr. Grey. She'll have to spend some time in the neonatal intensive care unit."

The pediatrician was handling the small baby very cautiously, he checked heartbeat and breath sounds as well as bowel movement. He examed the anus to check for anal atresia.

The A.P.G.A.R. score is used as a part of early assessment of a newborn in the 1 and 5 minutes after birth. The maximum score that can be assigned is 10. Scores ranging from 7-10 are considered normal. They were testing the baby's heart rate, respirations, skin color / oxygenation, reflex irritability to tactile stimulation and muscle tone and movement. But apparently something was wrong. Her baby wasn't adapting properly. She hadn't head Meredith scream or cry. The doctors worked on her, trying to get her to breathe. Someone had gotten her onto a monitor and was bagging her.

Ellis was scared but nobody was talking to her or telling her what was going on with her baby girl. She thought maybe it would be good to start praying for a miracle even though she wasn't even religious. But at that moment, she wanted nothing more than for her baby to live. "How is she doing?" Ellis asked scared.

"Let's prep her for transport to the neonatal ICU." Voices were talking quietly about her A.P.G.A.R. score.

Ellis figured that it was a low score. Both scores had been low.

And now appropriate measures were taken to make sure her baby was ok or at least going to be okay. Her thoughts raced. Why the heck was this happening? Yesterday, she'd been assisting in a surgery and now she was hospitalized and had just given birth to a preemie with a potential life-threatening condition. Why weren't they answering? This wasn't good.

It just couldn't mean anything and Ellis knew that.

"Pulse is below 100 beats/min, that makes 1 point." Ellis' heart felt like someone was ripping it out screaming, "screw you, Ellis" and then laughing. She wasn't regularly breathing and there was no strong cry. Her respirations weren't good either. It was somewhere between irregular, weak, slow and absent for some part, her skin color was between blue at extremities; pink body and cyanotic. There was some flexion. As for her refelex irritability to tactile stimulation - first, there was silence; no response to stimulation but then after some minutes, the little baby finally responded with a grimace and a feeble cry.

"What's her A.P.G.A.R. score?"

"Well, it's ..."

"Name me an exact number." The doctor said as she talked quietly with the pediatrician. Ellis had a bad, a very bad feeling about this.

Something was horribly wrong and she knew it.

"We'll have to do a more thorough exam in the NICU." Then they took her little girl away without letting her hold her for a second. Ellis closed her eyes in horror. She hadn't imagined that, it to be like this.

Two Hours later

When Ellis held her little girl for the first time she forgot all her worries. She forgot about surgery and how she missed out on amazing surgeries while being on maternity leave. She focused on her amazing, perfect, stunning, little girl. She was so sweet and she was the most beautiful baby in the entire NICU, although there were so many catheters, intravenous lines and the ECG electrodes that were monitoring her baby's heart rhythm. Meredith moved her a bit, kicking against Ellis' arms softly as she picked her up. She knew she should have waited for neonatal nurse to come here and supervise but she was a doctor, she knew how to handle babies. Ellis was happy, relaxed but tired after going through hours of intense labor.

They call it labor for a reason and now she knew why. But in the end it had been worth it. She knew that when looking at her daughter. A tiny, a little underweight baby who was very quiet. She wasn't screaming or crying. She was quiet. But she was looking at Ellis with childlike curiosity.

She saw her tiny face, her tiny feet and hands. Her blue eyes that had a shade of grey - she was beautiful.

"Meredith Grey."

That was the baby's name.

She was beautiful and despite her beauty and awesomeness, Ellis couldn't help but feel like something was wrong with her baby girl. She was cyanotic, her lips were blue but the doctors said it was due to her patent ductus arteriosus.

But Ellis knew it had been something more serious. Call it mother's instinct but nobody listened to her. They just a frightened mother and not a surgeon who knew about those things. But turned out her hunch was correct. There was indeed something wrong with her baby girl. She cradled her baby in her arm and was looking at her, for once enjoying this moment. "It's just you and me, baby girl. It's just you and me." She repeated.

"But we Grey girls do fine on our own, don't we?" Ellis cooed at her.

Meredith made a noise that sound like a giggle.

She smiled.

And for once in a very long time, she felt happiness creeping up in her. She didn't know that that happiness wouldn't last long.

But then her lips went cyanotic again and she seemed to be having a little trouble with breathing properly. She was breathing fastly and shallowly. Ellis grew worried. She was showing a lot of cardiac symptoms lately.

Maybe they should do a pulse ox to rule out possible CCHDs.

"I love you." Then she kissed her on her forehead and rocked her to sleep. Ellis watched the sleeping girl in her arms when a nurse knocked on her door and came in. "Hey, I'm just checking in." Ellis looked up concerned. "She's been getting getting cyanotic. I think you should do an ECHO. I'm a doctor I know the differential diagnosises. It could be something much more serious." Ellis was getting ready to fight for Meredith.

She is Meredith's advocate and parent, after all. The parent she has left.

"Mrs. Grey. I'm sure ..."

"How sure?" Ellis cut her off bluntly. "How sure are you that there is nothing wrong with her?"

"I ... I'm paging the pediatrician to look her over." The nurse said hastily.

A week later

It had now been a week since Meredith Grey was born.

At first, everything looked good so far. Her APGAR score had been a bit low, but besides that, everything looked as it should be. The doctors blamed her being born three weeks premature as the cause for the low APGAR score. Nobody ordered any tests to go any further. The doctors were sure Mer had been born healthy which turned out to be huge, undeniable mistake that almost cost her life. Because after three days her patent ductus arteriosus, full name is PDA, the fetal connection between aorta and pulmonary artery, closed, that resulted in her declining rapidly.

Her BE score was -7. BE was short for base excess.

Meredith suffered from metabolic acidosis that needed to be corrected. "We need to reopen her patent ductus to re-establish blood flow to the body. Her body cannot sustain this much longer."

They were starting to treat her for shock. She already was intubated and a vent was breathing for her so that they could control it. They did it because there were signs of pulmonary edema.

Their goal was it to get her oxygen saturation up to 95%. But that seemed to be difficult.

Ellis looked at the heart monitor.

Hoping that somehow everything would turn out alright.

She showed serious symptoms off cardiac distress and went into circulatory collapse because her aorta was interrupted, meaning her body wasn't getting enough oxygen, because the connection between the pulmonary artery and aorta was missing. Meredith showed early signs of heart failure due to pulmonary flooding.

It put additional strain on her heart.

After a while she was getting cyanotic, but it wasn't that clear because of the pulmonary recirculation. They thought it was due to the patent ductus arteriosus. But they were wrong. And the fact that they were wrong almost killed Meredith.

Her condition deteriorated fast. Too fast for anyone's liking.

"Why the hell is this happening?" Ellis screeched as they were working to get Meredith stable.

The monitor set off an alarm.

It was beeping.

The numbers and values were bad, indicating that there was something severely wrong with her daughter.

She cannot die, not yet. You can't go yet, Meredith.

Mommy won't allow it.

She thought as she was watching the pediatrician page Cardio.

"Page Cardio. Make it fast."

Someone screeched hasty orders and they all followed them quickly. Ellis didn't leave Meredith's side for a second. What if she left her just for a moment and her heart would just stop to beat? She'd never forgive herself if she wasn't there when it happened. "Nurse!" The doctor called as he was ordering an emergency echocardiography. Damn it, he thought. How could they have missed this? This is potentially life-threatening.

"You said she's healthy. She is not healthy. She is cyanotic."

The doctor was now giving her furosemidto treat her pulmonary edema and something for preload and afterload reduction. "Why was I paged?" The on-call attending interrupted loudly. "She's getting instable." One of the doctors called out.

"Do something to stabilize her."

No one looked up. They were all focused on Meredith.

"Don't stand there and just watch her die. Do something, stabilize her." Ellis told them, her voice breaking.

"Dr. Grey ... we're doing everything we can. But you need to go to the waiting room. We'll update you as soon as we get the chance-" His response was cut off by the cardiac monitor that started going off. Ellis diverted her glance the monitor and saw how Meredith's state was deteriorating before her very eyes.

This couldn't be happening. It just couldn't be ...

But it was.

But first, the physicians really did not respond. But then the doctors, in particular Ellis Grey noticed that she suffered from tachypnea, and besides, she´s had hepatomegaly, Meredith was lethargic and had poor feeding. And when they noticed there were blood pressure differences between her lower extremities and the upper body, the doctors thought for the first time of a congenital heart defect. As soon as they're had her stabilized, they rushed her into surgery.

"I'm sorry but we're ... we think there could be something wrong with her heart." The treating physician said.

"How could you have missed this?" Ellis asked, trying to be strong.

How can it be that they just missed it when assessing her using the A.P.G.A.R. score?

Why was it Meredith who has that kind of defect? Why was it her daughter who was born with that defect?

40 000 children are born with congenital heart disease annually, a lot of them live into adulthood - but still why her daughter? Why had Meredith been born with such a medical condition that will affect her troughout her life?

Her entire life ...

Because Meredith showed the symptoms of a severe coarctation of the aorta, the leading physician scheduled an echocardiogram. And it revealed something very shocking. "Okay, it's ... oh crap. " The ultrasound technian stopped at the heart of her daughter. He enlarged and reduced image and stared at the screen. Ellis was getting nervous. "What is it?" Ellis broke the tense silence. Only the clicking of the monitor could be heard. "There is, unfortunately, the suspicion that your daughter has a serious heart defect." The gynecologist told Ellis.

"A heart defect?" Ellis asked, shocked.

The general surgeon had to digest that fact for now. She'd been thinking this but that it actually happened is something else.

A heart defect?! That could be anything.

It can be small holes in the septum to highly complex malformations of cardiac chambers and the surrounding vessels. Heart defects were the most common congenital abnormalities in infants. "I'm about to page someone from cardiology and then ..." The doctor said: "It will be all right. The diagnosis of CHD does not mean that your baby dies. Today, there are ways and means to save the lives of these babies. Even highly complex heart defects can be treated well today. Listen, it's not hopeless."

Ellis scoffed.

"I know that. But even if you manage to save her, there's is still the possibitly of her needing another surgery."

Her voice quivered as she glanced onto the monitor.

The expresses the slimy gel on the transducer and started. First four-chamber view, then five-chamber view and then the heart valves ... They also looked on the monitor, clicked again and again to other views. But what had been discovered while performing the ultrasound was terrifying: Double Outlet Right Ventricle with TGA type and on top of that an interrupted aortic arch type A, where was an interruption of the aortic arch distal to the left.

"Oh, shit." She said softly.

"That can not be true ..." Ellis thought only after looking at the monitor. The pediatrician and pediatric heart surgeon were studying the images and talked for a while. Ellis was getting increasingly nervous.

What persuaded them for so long?

That could only mean that it was really a heart defect.

There are very many dangerous, sometimes life-threatening heart defects.

Double Inlet Left Ventricle Double outlet right ventricle, pulmonary atresia with ventricular septal defect, Left Ventricle Outflow Tract Obstruction, Hypoplastic left heart syndrome, Interrupted aortic arch, transposition of the great vessels, tetralogy of Fallot, unbalanced atrioventricular septal defect ... there were so many ugly possibilities.

Ellis gripped onto her little girl's hand. She was squirming, wanting them to stop pressing that uncomfortable, ugly thing at her chest. She whimpered. But they didn't show any emotions. But it was hard to watch for Ellis, like really hard.

Then the pediatrician turned to Ellis, a serious face expression.

"Er ... Dr. Grey, the ECHO revealed that Meredith is suffering from a complex congenital heart defect."

Ellis swallowed harshly. She couldn't believe it.

This was it.

Her daughter was going to die.

"She was born with something that looks like double outlet right ventricle with pulmonic stenosis and associated interrupted aortic arch." The pediatrician said. "That combination is causing her saturation to fall. It's also what's causing the cyanosis."

"Ok."

She stammered a bit as she said that.

Ellis Grey was overwhelmed by what she was just told. It seemed unbelievable. But then she arranged a transfer to Seattle Children's Hospital Heart Center to let them treat their daughter's heart condition. They tried to tell her that Meredith wasn't stable enough but they had already messed up enough.

Now she was riding in the back of an ambulance. A pediatrician was constantly monitoring Meredith's vitals in case she decided to crash again. But then they finally arrived, a competent group of doctors was waiting for them, Ellis was glad.

Now finally, her daughter was in good hands.

She watched them rush her inside, putting her on meds. Securing an OR for an emergent procedure and putting her on the OR board. Ellis let go for a moment, she was crying silently. Normally, she wasn't this emotional over something like this. But this wasn't a normal situation.

This was life and death - or touch and go - at the brink of death ... is what this was.

Her daughter was a patient.

A pediatric heart patient who will need specialized care for the rest of her life.

That she was born with a critical heart condition. She needed surgery. Needs surgery.

If she doesn't have the surgery, she could die.

She could die right now in this moment.

For a moment, she felt like she couldn't breathe. But then: "We need your signature to rush her into surgery." The pediatric cardiologist said as he looked at her empathetically. "We're so sorry." Sorry doesn't begin to describe her feelings, the grief, the pain, the unknown of what would be tomorrow ...

Maybe Meredith would be gone by then. Maybe she'd be dead - but maybe she keeps fighting and has a real shot at a life with quality of life. Ellis wanted her to have that shot. So she signed the papers that said she was agreeing to the surgery.

That was a shock for Ellis Grey, Thatcher had been gone by then and now she was all alone ...

However, it had missed out in the echocardiography that Meredith had been born with a complete atrioventricular septal defect, which is primarily acyanotic, but is fatal without treatment after 2- 4 years and causes pulmonary hypertension, and in final stages Eisenmenger's reaction with right -to-left shunt and cyanosis and congestive heart failure ... The weeks after the first cardiac procedure weren't easy for the both of them. For the time of her hospital stay, she had a epimyocardial pacer, the leads will be removed when she gets discharged. It's just a precaution but sometimes even that is necessary.

In Meredith's case it was indeed neccessary.

Ellis Grey remembered watching the surgeons, who rushed Meredith in the OR.

It was totally unreal. When the surgeons were no longer visible, the general surgeon sat in the waiting room for relatives and waited. There were others two, waiting and hugging, some were crying. She never knew how it felt to be the family in the waiting room. And it was horrible. Minutes seem to become hours, hours days and so on. Time seemed to pass slowly.

She was pacing, checking her watch every three seconds. Finally, she went down to the cafeteria to eat- she had to keep her strength up.

She had a feeling that she would be spending here a lot of time. But it was good that they were taking their time.

In the operating room

The surgeons just repaired the aorta. The surgeons opened her up through a median sternotomy and then put her on cardiopulmonary bypass machine which is required to take over her heart function, temp regulation and oxygen saturation. After the cannulation of the brachiocephalic trunk they stopped her heart with some kind of medication (pharmalogical cardioplegia) and let the CBM take over for now. But when you are working on the aorta, surgeons usually use a technique where they cool a body down and just perfuse the brain and that's what they did here too.

For a moment, only the beeping of the vent and the monitors could be heard.

The cardiopulmonary bypass had taken over heart and lung function as well as temperature regulation. The leading paediatric heart surgeon on the case just closed the ventricular septal defect trans-tricuspid. But it was a swiss cheese VSD. In the muscular septum was another hole and in the inlet septum too. A heart full of holes.

Meredith's heart was full of holes.

With continuation of cerebral perfusion the lead surgeon connected the aortic arch end to end and ventral augmented with a patch. Since the aortic arch was hypoplastic; which means it's too small and underdeveloped.

"Damn it, her aorta is hypoplastic. We'll have to perform a Yasui-operation." The lead surgeon said, throwing a glance at the head of his little patient.

Little and sick heart were his job. This was his job.

Fixing a heart

Trying to fix a heart ...

Giving the kid a shot at life ... that's what he was doing right now.

The surgeons performed a procedure called Yasui- operation, which means the cardiac surgeon anastomosed aorta ascendes und pulmonary artery side-to-side and extended it with a 8-mm polytetrafluoroethylene (PTFE) interposition graft from the ascending aorta to the descending aorta. In surgery they also did a pulmonary banding to prevent pulmonary flooding. However, they also discovered another additioning heart defect during surgery: Meredith also had an Atrioventricular Septal Defect (AV Canal Defect / Endocard Cushion Defect).

"Wait." The resident suddenly exclaimed as he noticed something.

"What is going on, Orenstein?" The surgeon asked gruffly. He was working very thoroughly, he knew that this girl was the daughter of a surgeon, of a colleague.

"Look, there is a hole in between the two atria." One surgeon said.

"What?" the other one exclaimed, he had not noticed that abnormality. He took a look himself and then only confirmed the other one's suspicion. There was another underlying defect here.

Another defect ...

Damn it.

"Damn it that complicates the whole procedure. What do we do now? Do we continue or do we close her up and only do a palliative procedure and then reopen her when she has gained more weight and is stronger to handle another surgery?" The assisting resident asked as he saw the extent of this, the extent of the defect. This was the important question, the question that determined everything following this.

"We close her up and then do a definite repair when she is three months or older." The professional tone of the lead surgeon showed no emotion.

He was cold, he has to be.

"Dr. Grey. We're here to update you on your daughter's condition." The older surgeon said.

"Is she out of surgery and in recovery? How are her sats, is she stable or ..." Dr. Grey asked, finally stopped pacing along the floor because she was worried. "First of all, your daughter is stable. We need to see if she makes it through the night. She'll need another surgery in a few months, when she is older and stronger. We have corrected the IAA, but not the Double Outlet left Ventricle. We also discovered ..." The doctor did not say anything straight out.

Ellis felt like he was hiding something.

She needed to find out what.

"What did you discover? There is no need to sugarcoat me." She demanded, her voice breaking slightly but soon she had the control back. "I am a doctor, a surgeon. So just tell me straight out." She demanded.

The surgeon nodded and answered: "In surgery we discovered an abnormal tricuspid and mitral valve. Also, she has an atrial septal defect that needs to be corrected in the next session and an Inlet-VSD. I am sorry." She has not signed consent on correcting the other defects. Ellis stared at the surgeon in utter shock and disbelief.

"What? You are kidding, right? This is not funny." She scoffed, not wanting this to be real.

Ellis didn't want to believe them.

How is she going to pull this off?

Without help and without a husband? How is she going to do this?

Her baby has a condition that probably will cause problems throughout her whole life and there was no one to help her. She was all alone.

Neither Thatcher nor Richard was here, she thought he was a wuss but still this was his child. Thatcher wasn't here, he didn't have to see his kid suffer through this.

She had no idea if she was strong enough for this.

And Richard, he'd gone back to Adele or something.

"We are serious. I am so sorry that we don't have better news for you." When the doctors told Ellis Grey about what they did find out while operating on her daughter's little heart, she just stared at them with disbelief and shock.

The world seemed to stop, she knew the freaking odds.

She could only picture the kind of life her kid is going to have. Nothing made any sense.

Nightmare, it was a freaking nightmare. You think you are immune against something like this, but in the end, there´s no difference between you and the rest of the world. Some surgeons may think that, but it is definitely not true.

This was a freaking nightmare for every parent.

Meredith was born with a complete Atrioventricular Septal Defect (AVSD / AVCD), an Interrupted aortic arch (IAA), Double Outlet Right Ventricle with TGA-type / sub pulmonic VSD, which means she´s suffering from a Taussig- Bing- Anomaly. Life is not fair. Life is never fair, but sometimes life is really biting you in the ass.

"Do you want to see your daughter now?" The doctor asked softly. "Yes." She answered and then she followed the doctor to die Neonatal Intensive Care Unit. When she saw her daughter lying there with all these wires and the epimyocardial pacer coming out of her, she tried to show no emotion. She was Ellis Grey, future world-class surgeon and cold. But this 'no emotion' thing ain't so easy. But she held herself together until the doctor left her alone. She looked at heart monitor, her heart was beating regularly. It showed a normal sinus rhythm. She was glad about that.

"Meredith." She just said her name as she was holding her little hand. She was still intubated. They'd probably remove in a few days. She always knew that she wanted to name her daughter Meredith. It was such a beautiful name.

"Fight, okay? I just need you to fight." She whispered. "Mommy's here."

But she had no idea whether Meredith was able to hear her.

When Meredith was ten days post-op, she started having arrhythmias. JET. Junctional ectopic tachycardia. It often occurs in infants and children who had open heart surgery recently. Postoperative JET usually begins 6-72 hours following cardiopulmonary bypass surgery for repair of congenital heart lesions. It is usually identified during monitoring in the ICU. A fall in blood pressure and cardiac output usually occurs concomitantly.

Her monitors started beeping loudly as they signaled a fall in blood pressure.

In general, postoperative junctional ectopic tachycardia occurs in the hospital with rapid hemodynamic instability. The doctors also noticed a decreased cardiac output. They suspected she is suffering from one dreaded postoperative complications after correction of congenital heart fault.

"She's suffering from a post-op complication is what you're saying?" Ellis sighed.

"Yeah, we believe she has JET that occurs after surgery in some cases and leads to hemodynamic compromise." The doctors told her. Ellis had to sit down. This was too much too fast. She couldn't believe it.

"What will you do?"

"We'll start diagnosing and treating it."

The rhythm disorder usually occurs 6-72 hours after surgery, and the patient involved is hemodynamically most severely compromised. That was what they suspected Meredith had. Ellis was the first one who noticed the signs and symptoms and called the surgeon who immediately started doing the physical exam and work-up. Maybe the tachycardia developed due to direct Trauma to the AV node, inadequate reaction on reperfusion after removal of the extracorporeal circulation or the anesthetics might have been the cause.

Meredith had all these symptoms. Also, a VA dissociation has occurred, which is usually the case, cannon waves may be present in the jugular venous pulse. The intensity of the first heart sound varies when the doctors listened to her chest. Meredith let out a weak sounding cry. That is when she turned blue.

Like you know, it was only palliative and not a definite correction.

She will need another surgery in a few months.

So, Meredith continued to cry and because of the uncoordinated beats of ventricles and atria as well as the tachycardia and increased oxygen consumption rapidly developed cardiac decompensation in Meredith. "It's okay. They're going to help you. It's going to be okay." Ellis whispered, trying to calm her down.

They took blood from baby Meredith and sent it to the laboratory to get it assessed.

They assessed serum magnesium levels, electrolyte levels, and lactate concentration. The surgeons also did a chest film to see if ventricular dilatation and dysfunction there (when signs of pulmonary edema are present) in all patients with JET.

Meredith showed signs of pulmonary edema.

They also did a repeated echocardiography to significant postoperative residual hemodynamic abnormalities.

Without proper treatment in earlier post-operative phases, the mortality is high, also because the normal antiarrhythmics aren't working.

Since amiodarone is comsidered as the most effective treatment when handling cases with Junctional ectopic tachycardia, the doctors gave her an i. v. of bolus or a short infusion over 30 to 60 minutes at a dosage. They also treated her pulmonary edema because the amount of fluid build-up wasn't causing any good. It was worsening her current situation. Well, to Support the drugs, the physicians also decided to try AV sequential pacing therapy treatment, can help to restore AV sequence and cardiac output once the JET rate is reduced. Meredith's heartbeat slowed down after 39 hours.

They also treated her with anti-congestive medication like digoxin because of the low cardiac Output and the heart failure. When Meredith's condition got better instead of worsening, Ellis was relieved. She knew it was not easy to deal with.

Having a kid with heart failure wasn't easy.

And this was just the beginning of their journey.

Meredith was at home. She'd spent one month at Seattle Children's. Two weeks in the neonatal intensive care unit and the other two in the normal nursery but was monitored regularly. Ellis had her transferred right after the diagnosis. They performed the surgery at a different hospital that was specialized in treating those kids. Since two days and Ellis has no idea how to manage being the mother of a sick child. Nobody teaches that. Nobody knew her daughter was sick. She never even told Richard Webber that her daughter wasn't healthy, that she was someone who had special needs, needed to measured and weighed on a regular basis.

She also needed all sorts of medication that should prevent her heart from failing. Meredith needed a lot attention. She was connected to a heart monitor to monitor her heart. Ellis knew how to read that kind of thing. She felt more at ease using that thing in case something happens it would set off an alarm, if there was a significant drop in her pulse ox.

She always had ice-cold hands due to poor circulation. Sometimes, she turned cyanotic since it was not the definite palliative surgery. It was only the Yasui-procedure. The final procedure was still months away. Ellis had no idea how to manage that.

Her sick daughter and then her demanding work schedule. She'd have to cut back on hours immensely.

She had no choice but to do that.

A/N: So this is the Prequel to 'Nothing Turns Out The Way Its Supposed To' and follows Meredith's journey from her dramatical birth to where she is now, an intern at Seattle Grace Hospital where she meets Derek. It also explores Ellis' and Meredith's mother-daughter relationship. Cristina will also play a major role in this fic. Yes, I said Cristina and I mean Cristina Yang. They've come a long way ... and something happened and Cristina moved. But Mer and Cristina knew each other from their childhood. Without realizing it when they both start to work ...

It shows how the great Ellis Grey copes with the fact that her daughter was born sick and there was nothing she could have done to prevent it from happening. Because sometimes, it just happens. Without an explanation for it.

It's like Ellis Grey said: "The carousel never stops turning. You can't get off."

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