"Ready for your first full day as Chief Resident?" Owen Hunt grins from the doorway of the residents lounge as April Kepner stashes her purse in her locker.

"Nervous but I'm ready!" she smiles as they walk toward the e.r. "Dr. Hunt, thank you, so much for this opportunity, I won't let you down."

"You deserve it Kepner. You're efficient, you're organized, you're great with patients. I'm looking forward to this year. I think you'll do great with this role."

The E.R. Phone suddenly rings and April picks it up, listening carefully. She turns to Owen. "Car crash victim, head on collision on it's way in." she continues to listen and turns to him one more time. "Page. O.B." the victim is 26 weeks pregnant."

"Alexandra Beckett, 32 years old, suffered massive head and chest injuries in a head on collision." the paramedics wheel her in 10 minutes later. The trauma team works frantically to assess her injuries, and confirm that the baby still has a heartbeat quickly after getting her on the table.

"She's got massive bleeding in her chest" Teddy confirms. "Let's get her upstairs, now."

"Is that... oh my God is that my wife?" A voice behind April frantically calls out as they wheel Alexandra towards the surgical elevator. April turns to face the distraught man.

"Mr. Beckett?" She asks

"Yeah. Um, is my wife... is she.. will she be okay?" he fights to catch his breath. "She was on her way to see her sister. She was 20 minutes from the house."

"Mr. Beckett, I'm Dr Kepner, April smiles kindly. Alexandra needs surgery immediately. We're going to take her up, and I'll keep you posted. I promise."

"And the baby? Is the baby okay?"

"The baby is still alive, and we're going to do everything we can to help them both." April pats his arm. "We'll do our very best Mr. Beckett."


By the time the team gets Alexandra open on the table, the news goes from bad to worse.

"We've got a lot of bleeding down here!" Teddy curses under her breath and looks up at Owen. She quietly shakes her head. "There's nothing I can do here. There's just too much damage.

"She's coding!"

Teddy charges the internal paddles, but it's no use. She looks up, and shakes her head again one final time.

"She's not coming back." Teddy says.

Owen motions behind him, "Let's get this baby delivered now while she's still got a fighting chance, we only have a few minutes people, let's move."

Moments later, the baby is delivered into the quiet, sterile operating room. While the NICU team works to stablize the baby, Owen looks across the table at April.

"Dr. Kepner, please call it."

"What?"

"She's your patient." Owen says.

"Time of death." April finally says, looking at the clock "8:22." She quickly leaves the room before anyone can see her emotions getting the better of her.

She brushes past Jackson a few moments later. "Hey are you okay?" He looks up with concern.

She shakes her head. "I lost my first patient as Chief Resident." she says. "She was pregnant. We delivered the baby, but she's a micro preemie. That kid...that poor tiny kid has already lost her mom."

"Hey. April. Come on." he follows her to an empty exam room and shuts the door behind him.

"That was a really tough case, the woman was in a major accident. You did what you could. At least you were able to save the baby. Let's look at the positives." he says, letting the door close behind him.

She looks up at him. "My first patient as Chief Resident and she dies. How am I supposed to tell her husband that she didn't make it? He has a 26 week preemie on her way up to the NICU right now, and his wife is dead, and that baby may die too. She shakes her head. "On my first day as Chief Resident, this is what I get." she mutters angrily.

"No one said it would be easy." he gently reminds her.

April rubs her temples. "I have to go and tell Mr. Beckett that she didn't make it."

"Do you want me to go? I can tell him."

She shakes her head. "She was my patient. I'll take care of it."


"Is Alex okay?" Noah Beckett asks as April quietly approaches him in the waiting area.

"Mr. Beckett." she begins.

"Please, call me Noah."

April nods. "Noah. When Alexandra was brought in, her injuries from the crash were catastrophic. I- I'm so sorry to have to tell you this but-"

"No" he whispers. "No you can't be serious, Dr. Kepner. Please! " he begs.

"I'm so, so very sorry." she repeats gently. "Alexandra didn't make it."

Noah buries his head in his hands, sobbing quietly.

"Mr. Beckett... Noah, I'm so sorry, but I do have something else to tell you." She quietly sits down across from him. "We were able to deliver your daughter." she bites her lip as he picks his head up.

"The baby lived? She didn't die?"

"Yes, she is alive right now. She's only about a pound and half, but she's strong. She's in the NICU, right now. I can bring you to see her if you'd like. Whenever you're ready."

Noah swallows hard. "Yes. I'd like to see my daughter." He says quietly wiping his eyes. "Can you bring me to see her?"

"Of course I can."


The elevator ride up to the NICU is stone silent. Noah continues to cry silently to himself as they approach the NICU door. " I just can't believe this is happening." he whispers.

April steadies herself, and hands Noah a NICU gown. "You need to put this on, it helps to protect the preemies in the NICU from outside germs." she explains, before taking a deep breath. "Noah, you need to prepare yourself for what you're about to see."

"Okay."

"Your daughter is very, very small, she doesn't look like a normal baby, and she's in an incubator. You're going to see a lot of tubes and wires. I want you to know that this is all normal, and to be expected for a preemie. She's not able to breathe on her own just yet, so she has a tube in her throat, connected to a ventilator. It's a lot, and it's overwhelming. But, it's normal."

Noah nods. "Okay. I understand."

April swipes her badge, and the NICU door unlocks.

"It's so quiet in here." Noah whispers, looking around. "So much equipement for such tiny people."

April smiles at Jodi, the charge nurse. "Jodi, can you show us where the Beckett baby is, please?"

Jodie nods, and smiles kindly at Noah. "Of course, come on over here."

April and Noah follow Jodi to the far corner of the NICU. "Here she is Mr. Beckett. Go right on up and say hi." Jodie encourages.

Noah's red eyes overflow with tears as he peers into the incubator at his little girl.

April holds back her own tears as she stands on the other side, and peers down at the baby herself. "45 minutes old is way too soon to have already been dealt your first loss." She thinks to herself. She listens silently as Noah effortlessly whispers to the baby, while wiping his tears away every few seconds.

"Hey... in there," he starts. "It's me. It's daddy. Do you recognize my voice?" he pauses for a second and takes a deep breath.

"I just want to tell you I love you, Daddy loves you so, so much." He shakes his head and buries his face in his hands again, standing over the incubator.

"Noah do you want to sit down?" April asks softly.

He shakes his head, and looks at her. "What the hell am I going to do?" he asks her. "I'm alone. And she needs her mom. I don't know how to do this without Alex. I can't. I can't do this alone."

April grabs his shaking hands. "You're not alone Noah." she whispers.