Hey! This will be set in the present day and I've made some changes to Derek's family. Instead of only having sisters he will also have two brothers. I will write the names and ages here just incase I include them in future chapters! I'll also include Derek's age too. Please rate and review! :)

Callum: 40

Nancy: 38

Robert: 35

Kathy: 33

Derek: 30

Liz: 27

Amelia: 23

Phoebe: 15

"Are you in or out Shepherd?" Webber repeated impatiently. "Shepherd!" he shouted, anxiously trying to obtain the surgeon's attention. Derek was quickly jolted out of his thoughts.

"In or out for what?" He asked, slightly embarrassed at his uncharacteristic absent mindedness.

Webber sighed, growing increasingly annoyed with Derek's lack of focus. "Are you scrubbing in?" He repeated slowly, annunciating each syllable as if talking to a child. "Although, I'm a little afraid to ask at this point…"

Derek bit his lip, trying to resolve the internal struggle plaguing his mind. He really should head back to the house. Mr. Ellis would be there within the next few hours to drop off Phoebe. He couldn't help but assume that being present to receive custody of his little sister should take precedent over his work. But still… passing up any surgery, was a deadly sin at Seattle Grace Mercy West - especially with Richard Webber.

"I'm in." He said, snapping back to reality. And I'm a horrible brother. He thought glumly.

"Great, let's move it." Webber relied, turning towards the pediatric wing. "We've got an 11 year old male, admitted with severe abdominal pains. He will be undergoing an appendectomy today… unless there is something else you would rather be doing." He added at the end, wanting to make sure he knew that he had noticed his spacey behaviour.

Derek resisted the urge to roll his eyes. Of course I can do an appendectomy, it's only the easiest surgery known to man. He knew he was being stupid, risking not being home when the social worker arrived...but he couldn't pass up this surgery… regardless of how minor it was.

Webber wasn't one to make conversation when there was business afoot. Derek couldn't help but notice that despite his age, he sure could book it down a hallway in record time. He struggled to keep up with his quick pace. People tended to part and make way for him, to prevent themselves from getting knocked over. Derek had to push his way past fellow doctors to avoid losing him in the process.

When they finally arrived in the surgical preparation room, a large smile formed on Webber's face. He was one of those people who truly loved his patients. It was only with the doctors, nurses and interns that he tended to be cold and strict towards. "Hey there Josh." He greeted cheerfully.

The small boy offered a nervous wave with one hand and clutched onto his mother tightly with the other. She smoothed his hair out comfortingly. Derek couldn't help the butterflies that formed in his stomach at the parental action. Was he meant to do stuff like this starting from today? Would he have to comfort Phoebe when she was scared? Would she want him to? Would he have to help her with her homework? Cook for her? He had no idea how to be a guardian… sure, they were close and Derek loved her to bits but looking after a 15 year old 24/7 was a different matter entirely.

"Alright Mrs. Matthews, we're getting ready to take him down. We're going to have to ask that you head to the waiting room. Someone will be out with an update as soon as we're finished. It won't take long." Webbe informed the patient's mother.

Mrs. Matthews nodded and Derek turned away so he wouldn't have to see the final exchange between mother and son. It was too much of a reminder that he should be at home waiting for Phoebe… not doing an operation.

After his mother was gone, Derek picked up the boy's chart and scanned over it quickly. He wanted to make sure that he had all of the basics covered because Webber would be asking him questions during the surgery. Webber liked making sure that all his staff never forgot what they were doing and why they were doing it.

"Am I going to have a scar?" The young patient piped up worriedly, staring up at Derek with wide brown eyes. Derek stopped prepping for a moment and came down to the child's level.

"Yeah bud, you will." He replied honestly. The boy lowered his head, allowing his sandy blonde hair to fall over his eyes. Derek glanced at the chart quickly, searching for the boys name. "But… I'll tell you something Josh." Derek began quietly, glancing around as if he was about to reveal a huge secret. "Chicks dig scars." The boy's eyes brightened slightly, and Derek sighed with relief as he began to wheel the bd out the door.

"Are you ready?" He inquired.

"I guess." Josh replied as he offered a small shrug.

See, I'm not so bad with kids. He decided happily. Although, the real test was soon to come. Then again, he didn't know if he should consider Phoebe as a child anymore. After all, she was fifteen.

He felt like the worst big brother on the planet. Although he rang her regularly and sent her gifts every now and then, he only saw her in person 4 or 5 times a year. However, social services saw him and Meredith as the best option for her. Not just any girl though, a traumatised teenage girl who had just watched her mother and father get murdered. It made him sick to his stomach to think what she had just been through, his baby sister, the little brunette girl with braids who used to look at him as if he made the sun shine.

Derek entered the O.R. his thoughts still preoccupied. He quickly scrubbed his hands thoroughly, pulled on his mask, and pushed open the door using his shoulder.

"What do you say we take care of that appendix?" Webber said, sounding slightly muffled through his mask. Derek walked around to the side of the operating table as the anesthesiologist entered the room. Josh looked up at him, his eyes full with panic. Derek gave his shoulder a reassuring squeeze.

"Josh," he spoke softly, "this man is going to give you something to make you go to sleep and when you wake up, you are going to have a super cool scar and an excuse for your parents to give you ice cream whenever you want." Josh seemed to relax slightly at Derek's words. They waited patiently to get the green light.

"Alright, let's get started." Webber initiated the start of the surgery, handing a scalpel to Derek.

The surgery was quick, as appendectomies usually are. Without complications, they are almost always around 45 minutes long. This one had been slightly less, due to Derek's level of training and experience. He hoped the social worker was still at the house, he hoped he hadn't blown his chances with her over Phoebe's custody arrangements. But then again, maybe Mr. Ellis wouldn't mind waiting for another 20 minutes for him to get back to the house. Mark and Lexie were there. Derek was confident in their ability to keep him from putting his sister on the next plane back to New York.

Derek didn't have to wonder for long. As soon as he walked through the double doors that led to the main floor of the hospital, he was face to face with a tall, blonde haired man in a grey suite with matching pants. He looked exactly how he would have pictured a social worker. His demeanor was serious, but his appearance gentle. His posture was straight making him look taller than he was.

"Dr. Derek Shepherd?" He asked, glancing down at the clipboard clutched in his huge hands.

"Yes." Derek verified, suddenly noticing his sister standing shyly next to him. Seeing how grown up his little sister was almost brought him to tears even though he had seen her 3 months ago. She was small, somewhere around 5'2. She was also very thin, but very athletic, sporting a purple varsity sweater. Her wavy, brunette hair hung down past her shoulders, framing her face

"I'm Jacob Ellis. I arrived at your house about an hour ago, but one of your roommates told me that you got held up in surgery. I assumed that delivering the final paperwork here would be easier for you than rescheduling." The social worker said, his tone stiff and professional.

Derek made a mental note to thank Mark or Lexie for telling the social worker where he was. "Yes that's fine. Would you like to go sit down where we can go over it?" He asked. He nodded and followed Derek as he led them to the resident's lounge. Phoebe walked behind them and tried to keep her tears well hidden.

They sat on the round table at the back of the lounge. Phoebe sat as close to her brother as she could. Derek's heart swelled slightly seeing that she still idolised him. Phoebe folded her arms slightly and Derek looked at her. His heart broke seeing her red eyes and the slight black underneath them from lack of sleep. He gently brought his hand up and rubbed her shoulder softly. All Phoebe had to do when she was younger was bat her eyelashes and pout at him and he'd give into her.

Mr. Ellis slipped on a pair of reading glasses and detached a thick packet from his clipboard. He got directly down to business.

"Social services has come to the final decision, seeing as the mother, father and the other siblings are unable to provide care, the minor, Phoebe Shepherd, will be placed in the custody of her older brother, Derek Shepherd." Derek nodded slowly. "Sign here." Mr. Ellis dictated, handing him a pen. Derek scribbled his signature down and waited for him to continue.

"I understand that you work an impressive number of hours per week, which is a legitimate concern when awarding custody of a child. However, you wrote that you live in a house with four other doctors, all who are aware of and have offered their assistance and support with your situation. I have statements here from Dr. Meredith Grey, Dr Alexandra Grey, Dr Mark Sloan and Dr Alex Karev. Is this your current living situation?"

Derek nodded his head. They had all told him and Meredith repeatedly that they did not mind his sister moving in. Mark had even moved back into the attic room so that Phoebe could be closer to himself and Meredith, but he still felt guilty about potentially having to rely on them all so much.

"If you will put the date and your signature at the bottom of the page, I officially grant you custody of Phoebe Shepherd. Remember this can change if you don't provide sufficient care. You will get a visit in six months to check on your progress."

Gripping the pen sharply to steady his hand, Derek signed and dated the page. He exhaled deeply as he set the pen down and slid the stack of papers back to Mr. Ellis.

"Congratulations, and I wish you both the best of luck." He gave Phoebe's shoulder a pat and offered a smile before collecting his briefcase and letting himself out the room. Derek sat next to his sister, willing to say something. She remained silent, her gaze fixed downwards. After what seemed like forever, she finally spoke.

"Why didn't the others want me?" She asked softly.

Derek sighed softly and rubbed the back of his neck. His mom and dad had 8 children - five girls and three boys. Unfortunately they all lived too far away. But to a 15 year old girl it looked like her big sisters and brothers had abandoned her. He reached out and took her hand in his, "They all live too far away kiddo. Not to mention they either have kids or work unpredictable hours without the support I have. They still love you just like I do." Phoebe smiled softly.

"Why don't we go home? We can see Meredith and Mark. I'll introduce you to the other two members of the house. Does that sound good?" He asked gently. Phoebe nodded and stood up.

The drive home was mostly silent. He attempted to make small conversation, but failed at it. Phoebe was deep in thought or trying not to let her emotions out in front of her brother. They pulled into the driveway and Derek surveyed the various parked cars to determine who was home and who remained at the hospital. Alex was home, it was his day off. The second car belonged to Mark and Lexie.

Phoebe followed him into the house through the back door, leading to the kitchen. Mark was sitting at the bar drinking a beer and reading the sports section of the newspaper.

"Hey Derek, did everything get sorted?" He asked, folding his newspaper and setting it in front of him. His eyes did a double take when he saw Phoebe, she'd grown so much since he last saw her. He smiled slightly at her and ran his hand through his hair, "Hello trouble!" he held his arms out.

"Mark!" She flew into his arm and buried into his chest. Mark put one arm around her body and used the other to stroke her hair. "Yes everything is sorted." Derek relaxed slightly and grinned at the interaction between his little sister and his best friend, the man who was like another brother to him.

"Is Lexie here?" He asked curiously just as Phoebe was pulling away from Mark.

"Yes, but she's asleep. She's on call tonight." He responded. "Oh by the way, the social worker left Phoebe's bags in the foyer."

"Thanks Mark."

"No problem."

Derek started to walk through the house and into the foyer. Three large bags sat at the foot of the stairs. "Is this everything?" he said softly and picked the bags up in his strong arms.

"Yeah." She whispered softly and followed him up the stairs.

"This is your room." He said, pushing open the door. "Mine and Meredith's is just next door in case you need anything. Although knock first."

Phoebe pulled a face and watched as Derek put the bags in front of the queen size bed, which was now covered with a pink and blue duvet cover.

"I remember you said your favorite colours were blue and pink so I thought you might like this…"

Phoebe smiled a genuine smile, "It's great, thanks Der. I guess I'll unpack now."

Derek lingered in the doorway before finally saying something, "You know that I'll take care of you don't you? I love you."

Phoebe put her bag down and flew into his arms, nearly knocking him over. "I know. I love you too."

Derek cradled her in his arms and felt his heart swell. He pressed several kisses to her forehead before pulling away. "I'll give you sometime to unpack." He released her and went downstairs.

"She's grown so much." Mark commented as Derek came back into sight. "Looks very similar to Amelia."

Derek nodded in agreement, "This almost seems too easy. I just hope that I can do right by her. It's one thing being the doting big brother who sends her a couple of gifts every month but it's another thing to actually be like her dad." He muttered.

"Give it time." Mark advised as he shuffled through some papers. "Chinese?" He grinned, holding up a menu.

By the time the food had arrived, Alex and Meredith had returned from the hospital, both after finishing a 16 hour shift. The bags under Alex's eyes were starting to develop their own set of bags, but they were happy nonetheless. Derek decided that it was a good thing. Phoebe might as well get a feel for what life in this house was really like, sleep deprivation and all.

Derek walked down the hall and spoke to his sister. Phoebe had asked for egg fried rice, chicken chow mein and deep fried prawn balls with sweet and sour sauce. Derek was thrilled with his sister's appetite and went downstairs to Mark to tell him what they were ordering.

"Phoebe! Dinner's here. Come to the table." He told her, waiting at the bottom of the stairs.

Phoebe stood up slowly and made her way down the stairs and to the table. Sitting down next to Meredith, she grinned, "Hey Meredith!"

"Hello sweetheart!" she exclaimed and placed a loving kiss on her forehead. "ALex this is Phoebe, Phoebe this is Alex." She said gesturing to Alex. Alex waved.

Everyone began to tuck into their food, Phoebe eating slightly faster than the others. There was small talk going round the table while everyone enjoyed their meal. Phoebe finished and jumped up, "Derek I'm going to bed. I'll see you in the morning."

"Ok. Goodnight, kiddo." He said warmly and helped clean up.

Phoebe rushed up the stairs to the toilet and locked the door. She turned the tap on and leaned over the toilet. She lowered down and stuck her fingers down her throat and puked up as much food as she could get out. Soon, nothing but bile and stomach acid was coming up and Phoebe sat there with tears streaming down her face. Getting cleaned up, she went back to her room and went to bed feeling very ashamed. No one will want me after this.