Chapter 2 "A Long Way Ahead"

After a trauma your body is at its most vulnerable. Response time is critical. So you're suddenly surrounded by people. Doctors, nurses, specialists, technicians. Surgery is a team sport. Everyone pushing for the finish line. Putting you back together again. But surgery is a trauma in and of itself. And once it's over, the real healing begins. We call it recovery. Recovery is not a team sport. It's a solitary distance run. It's long, it's exhausting and it's lonely as hell. The length of your recovery is determined by the extent of your injuries. And it's not always successful. No matter how hard we work at it, some wounds might never fully heal. You might have to adjust to a whole new way of living. Things may have changed too radically to ever go back to what they were. It might not even recognize yourself. It's like you haven't recovered anything at all. You're a whole new person with a whole new life. Meredith Grey; It's A Long Way Back

"Are you sure she is stable enough to be discharged?" Ellis asked, sounding scared. "Yeah. We've been monitoring her progress very closely and for now, she is doing good, considering the defects she was born with and the fact that she was rushed into surgery after her ductus closed." The pediatric surgeon smiled at her, whose lips formed to a happy smile. The scar was there, red and going through the middle of her sternum. They had divided it. They had stopped her heart in order to repair it. For Ellis Grey that seemed unimaginable. She still couldn't think about what would have been if this had ended differently ... because it could have. Meredith not being able to come off bypass 'cause her heart is too weak to take up its function ... Then she would have been on ECMO. And that would not have been very good. "Dr. Grey?" The doctor asked as Ellis didn't react right away.

„Dr. Grey?"

She has seemingly spaced out, apparently. "Uhm, what were you saying?" She asked.

The doctor cleared his throat, then he repeated the sentence.

"We just need to confirm that everything is looking good with a post-op ECHO and of course electrocardiogram. She will have to take certain medication. She'll tire more easily than other babies her age. Meredith will need a lot of attention, a lot of help." The doctor said as he started listening to Meredith's heartbeat. "I am aware of that. This isn't the first time I have seen such a condition." Ellis replied to his question. "What meds will she have to take?" She then asked.

"I can tell you more about that after the ECHO. But for now, I think it's safe to remove the external pacer leads." The pediatric surgeon said. A lot of people have cared for Meredith during her stay at Seattle Children's Hospital. She was now a lot stronger than before the surgery.

But there was still a significant difference between her and a child born with a healthy heart.

"Okay, let's do it." Ellis said decisively as she cradled her daughter on her arm. Even though Meredith was now in a regular patient room, she was still attached to a portable heart monitor that was beeping rhythmically. "Ok, follow me." A nurse came and carried the monitor while Ellis carried her baby. They entered exam 5. Ellis saw the machine used to perform an echocardiography. Child-friendly figures could be seen on the walls in a lot of colors. "I will start by listening to the heart sounds." He explained. "i know. Just … do it, please. I know how this works. So do whatever's necessary." The general surgeon advised him. He only nodded. Meredith, who was still in her mother's arms, squirmed when he came nearer with that thing. "Sh, it's okay." Ellis murmured, noticing her child's discomfort. "It will be over before you know it." Upon hearing her mother's voice, Meredith was more willing to let the doctor do what he needed to do.

"Can I?" He asked in a soft voice he only used with children. With the heart patients he worked with ... and now it was Meredith Grey.

He had warmed the stethoscope before putting it on Meredith's chest. Apparently, Meredith appreciated the warmth coming from it and her arms were soon reaching for it. The pediatric surgeon started the exam with listening to Meredith's heart. Of course, there was a heart murmur since they haven't corrected every anomaly they found. They would have to do second surgery to take care of that. There was a sound coming from the ventricular septal defect and the atrial defect as well as the common AV valve.

"Yeah, I know you wanna try it out, huh?" The doctor chuckled as he interacted with Meredith.

Meredith giggled in response.

For once she was stronger than she was before surgery. Ellis Grey only nodded. Seeing the red and pink line across Meredith's chest, bisecting it ... She had a feeling that this wouldn't be all. That there would be a lot of more hurdles to go through … But it's better not to know everything ... if you did, when would you find time to enjoy life?

Then the doctor began with the ECHO. He felt Ellis staring at him as he evaluated the pictures. He turned the screen away from her so that she wouldn't see what the pictures showed.

"Hey, what the hell are you doing?" Ellis exclaimed as she lost view of the screen.

"I was just ..." He stuttered, knowing himself that it wasn't very professional but he just couldn't help it. "It's better if you don't have to see this, especially when you know how to read an ultrasound."

"Whatever, turn it back." Ellis said slowly.

She was very insistent.

"Please."

She added as he sighed and reluctantly pushed the screen back to where it was.

"Good." She only said in reply.

But he didn't think that Ellis would make him turn the monitor so that she can see what the screen was showing, what her daughter's little heart looked like. She saw the common AV valve, the multiple defects in the ventricular septum as well as in the atrial septum, the great arteries – both supplying the right ventricle, meaning the blood was mixed, resulting in cyanosis.

There was a high shunt volume. She saw that. Meanwhile, the doctor was quantifying the shunt.

But as the doctor pressed the transducer a little harder onto Meredith's chest, she started crying. It wasn't unsual for babies to do so when performing such a procedure. He knew a lot of babies did that. He'd seen a lot of baby hearts.

He'd seen a lot of responses like that.

After completing the exam, having looked at her heart in all the different modes such as four-chamber view, five-chamber view, parasternal view, M-Mode … the doctor put the transducer away and turned to Ellis who was still focused on the monitor. Meredith's heart was still on screen, frozen. "So, everything looks as expected after this type of surgery. There is less pulmonary flooding due to the pulmonary banding but there is still a significant shunt. You will have to come to a repeat ECHO every two weeks until definite surgical palliation can be performed."

"Isn't there any chance that the next surgery can be a corrective procedure?" Ellis asked.

But the doctor shook his head resignedly.

"Sadly, there isn't. But there are other options. From what I have seen your daughter looks like a good candidate for an atrial switch surgery also known as …" "… Senning procedure." Ellis interrupted him. "You know about those things?" The pediatric surgeon asked surprised. He didn't know that. Ellis looked at him, sending daggers at him with her eyes before saying: "I'm a third year surgical resident at Seattle Grace Hospital. You bet I do, I know about those things!" Ellis glared at him. The pediatric surgeon smiled lightly. "So I guess, I don't have to explain how this works?"

"I'm not in the mood of hearing medical terms and processing what they mean. So just talk to me as if I were any other parent with no medical knowledge." Ellis just said, breathing in tersely.

The pediatric surgeon turned to Ellis, clearing his throat before starting to speak.

"Uh, right." The doctor started. "An atrial switch operation is a surgery in which we create a conduit within the atria that reroutes the oxygen-poor blood. The anatomic left ventricle continues to pump into the pulmonary circulation and the anatomic right ventricle will work as the systemic pump, in other words the ventriculo-arterial mismatch is left unrepaired."

"Wait. I ..."

"So in other other words The left ventricle will pump the blood to the lungs while the right ventricle is working as the systemic pump?" Her voice shook.

"Yes." The surgeon said deadpan.

"Oh my ..."

"Do you need a minute to regain your senses?" The surgeon asked, trying to offer comfort, knowing that there wasn't much comfort that could be offered in such a situation.

"I'll send the nurse with discharge papers." He said. "This first surgery has been successful."

"I know. If it hadn't been, she wouldn't be alive." She sighed before asking a question she needed to ask, needed to know the answers for: "Is there anything I need to look for? Symptoms that indicate that she's getting worse? What kind of things do I need to look for?"

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. 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 knew there would be additional surgery since this defect was too severe to get better on its own ...

But now she was standing outside Seattle Children's with her daughter's small body softly pressed against hers and full of gratitude. These doctors had saved her baby girl, giving her a shot at life with that surgery.

Without that surgery, she would have been dead by now.

It was a miracle that she survived. It has gotten noticeably colder and she saw that even though Meredith was soundly asleep, the cold seemed to bother her.

Then the cab she called arrived.

After Ellis put Meredith in a car seat and then sat down next to her, the cabbie asked for their destination. Without looking up, Ellis answered: "612 Harper Lane; Queen Anne Hill, Seattle." That's when the cabbie started driving. When they reached the house Ellis lived in, she paid and soon they were home, just in time for Meredith to be fed. "So, let's get you settled in." She murmured softly, knowing she was doing this alone.

At that moment, Meredith started crying loudly.

"Sh, I know you're hungry, just a moment then I'll be ready."

Soon, Ellis had warmed up a bottle of formula with additional calories – although she was sure, she would have to give her half of it through the feeding tube – and started feeding her. After a few minutes, Ellis noticed the growing drowsiness of her daughter. She almost started sleeping while eating. Meredith was still very slender, even for her age.

And then the problem with the eating ...

Ellis sighed. That's what was hard. Watching her baby not even being able to eat properly because it was so tiring for her.

She even had a feeding tube because she got too tired when trying to eat so they had to look into other options to make sure nutrition is adequate. That was because of the heart failure.

She had noticed that when she tried to feed her three weeks post-procedure. But Meredith had gotten too tired after only drinking a bit. She'd also been sweating so Ellis called the doctor and they decided it was best to try it with high-calorie formula that had special nutritional supplements added to formula that increase the number of calories in each ounce, thereby allowing Mer to drink less and still consume enough calories to grow properly. But even that hadn't worked and in the process, Meredith started losing weight which was alarming. So they opted for supplemental tube feedings given through a small, flexible tube that passes through the nose and into the stomach, so that when she got too tired to continue eating the rest of it would be given through the feeding tube.

After that, Meredith slowly started gaining weight and that was a relief for Ellis.

She also needed all sorts of medication that should prevent her heart from failing. They wanted to try and manage her heart failure by giving her Digoxin, that's supposed to help strengthen the heart muscle, enabling it to pump more efficiently, and diuretics to remove excess fluid from her body as well as ACE (angiotensin-converting enzyme) inhibitors that dilate blood vessels and as a result, they make it easier for the heart to pump blood forward into the body. 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. But that was ok. She just hoped her superiors would understand why she was taking the maternity leave for at least half a year. But she would do that, sacrifice her work life for Meredith's well-being. But it wasn't Meredith's fault that she was born sick. It was not anybody's fault.

One month later

Ellis was getting the hang of it. She knew what Meredith needed, how to calm her down when she was fussy. She had adjusted to her life as a mother of a kid with heart failure. It was an advantage that she was a doctor. She had a routine. First thing after waking up was feeding her baby, then giving her the needed medications she was on and then, depending on how well Meredith's state was, she went to the park with her. She wasn't old enough for the playground but the fresh air was good. One day as she was pushing her baby girl in a stroller she met Richard. "Hey, Ellis. Long time no see. When are you coming back to work. I miss having you there." Ellis frowned. "Well, it'll be awhile before I will be back, especially under these circumstances." Damn, she shouldn't have said that. It was a hint, a hint that signaled that something was wrong. Ok, something was wrong but there was no need for the whole world to know. "What circumstances?" He asked.

He was eyeing her cautiously, then the little baby. Thankfully she wasn't cyanotic right now.

Because then, Richard would know that something was wrong with her baby girl's heart (or lungs). He was a doctor after all. He wasn't dumb either. He'd figure it out.

"I just had a baby." Ellis sounded a little bit offended. "One and a half months ago." Richard said. "You basically lived in the hospital and now? What has changed?" He just wanted to understand. Her Chief was on the line, he wanted her to come back as soon as possible. Ellis Grey couldn't believe it. What the hell? She'd just given birth to a very sick baby girl that needed more attention than a healthy baby her age.

"However, it's nice to meet you, though. Adele wanted me to ask you if you wanted to come over for dinner. She wants to meet little Meredith."

Oh crap.

Ellis desperately tried to think of a reason that could let her avoid having to meet Adele and bringing her baby. She feared that this would be too much stress for her. Also, Meredith would have to go back to the hospital because of the second surgery. She knew it would be soonish. Also, there was a higher risk of her catching something before surgery and then they would have to postpone it which wasn't exactly ideal.

"Richard, I can't come to your dinner."

"But why not? You can come over and have dinner with us ... what's so wrong about dinner?" Richard Webber insisted on receiving an answer. What was so wrong about dinner? Maybe the fact that she didn't wanna face Adele …? Or that it would be awkward? A lot awkward considered they have had an affair over the last few months and now he playing happy family with Adele. No, she didn't wanna see that. "I have a child to care for." Ellis used Meredith as an excuse for not having to meet Richard and Adele since that would awkward.

A sick child …

"You can bring her, Adele and I would love to see her." Richard simply answered. "But sometimes things aren't this easy and this is one of those things. I can't bring her." Ellis insisted.

"Why can't you bring her? I mean I don't see a reason why you wouldn't be able to take Meredith with you?" He looked at the little girl in the stroller and on his face formed a bright smile. She really was gorgeous. "She's adorable." Ellis didn't know what to reply. What exactly should she say to that?

She can't, or more, wouldn't tell him that Meredith was sick.

Richard seemed to notice that she wasn't comfortable with talking about that topic so he switched to another topic.

"When will you be back at work?"

"Oh, is Jensen already talking about replacing me? I had a kid and I will back at some point. But right now I just go to work, knowing that some nanny is supposed to take care of my child." Ellis answered, her voice getting louder at the end of the sentence. Then there was silence between them and Richard knew that he had said the wrong thing. But now he'd already said and there was no going back. He cleared his throat. He saw that something was off. But he couldn't place it.

He looked at the baby that was sucking on her thumb.

"Ok, change of topic. What about the dinner?" Richard said awkwardly. "I'll think about it." Ellis avoided the topic. "It would be nice if you'd give me answer before Sunday, ok?" He asked. Ellis only nodded in reply. What else should she have said? After Richard wasn't there anymore, Ellis cursed herself for not saying no right away. Because she couldn't go to that dinner, could she? There was too much history, right?

She had no idea what to do.

A weak cry interrupted her train of thoughts. At that point she became more conscious of her surroundings and why she'd come to this park at all.

"Sh, everything's fine." She walked around so that she was facing Meredith. Carefully, she lifted her up.

Richard watched her doing that.

Then she rocked her softly so that she would stop crying.

"So, I just have to ..." Before she was able to finish that, she heard the ringing coming from the door. Probably the nanny, luckily she wasn't late. Ellis was relieved about that. Although she didn't really want to leave Meredith to go to that stupid dinner. But Adele and Richard had insisted and then she caved. But she wouldn't be bringing Meredith 'cause she feared that that would too much stress and too much to handle for her. So she hired a nanny. Ellis hurried downstairs when she heard that someone at the. That would have to be the nanny that is supposed to look after Meredith while she was attending that dinner. "Coming." She called out as the ringing came in closer together. "I will be there in just a minute." Meredith was upstairs, sleeping in her crib. She hoped Meredith wouldn't wake up any time soon. Then she opened the door and a middle-aged woman was standing in front of her. She was smiling in a friendly way. "Hello." Ellis was the first one to speak. "I'm Dr. Grey. May I ask who this is?"

"Anne Wilkins, we talked on the telephone. You hired me to babysit." The woman replied.

"Uh, yeah, I did. Come in." Ellis stammered.

Anne entered the house, looking around lurking. "So you've got a nice house here." She started making smalltalk. "I do. I have a dinner to get to, in about twenty minutes so let's make this short: My daughter's name is Meredith Elizabeth Grey. She's almost three months old and has had an open-heart procedure at the age of seven days. She spent her first month of life in the hospital and needs to take medication to treat her heart failure symptoms."

"WHAT?" The nanny exclaimed, she hadn't thought that the kid she'd be looking after, has major medical concerns.

Like congestive heart failure due to a congenital heart defect.

"Meredith has a heart defect. She needed surgery and there will be another surgery to complete the partial repair." Ellis told her about the cardiac condition Meredith was born with.

When she was finished she stammered: "Uh, okay. I can manage that."

At the end of the sentence, she was sounding more and more confident about the whole thing. "Good." Ellis replied.

"If something happens ..." She started giving instructions to the nanny who was standing there, facing Ellis. Anne listened to what she has to say. "... you call this number right here." She was now pointing at a note pinning near the telephone. She'd written down the number for Adele and Richard's landline in case something happened. She needed to take these precautions. "I will then instruct you on what to do next. If nobody answers, you call Seattle Children's Heart Center and ask them if you should bring her by for a consult and try to reach me. You got that? This is important."

"Where is she now?" She then asked.

"She's upstairs, sleeping."

They both went upstairs and Anne met Meredith for the first time. She was soundly asleep but looking so small. "So now that you know, I can go and make it to the dinner party or whatever it is." "Yeah, you can go. I got this." Anne smiled reassuringly. Ellis turned around and scurried to the door. She didn't stay very long at the dinner party, only one hour before she excused herself. She didn't like talking to Adele as if she and Richard weren't ... That seemed wrong.

Wrong in so many ways.

When she got home, Anne had just started to feed Meredith. Ellis opened the door and entered her house. Her keys were in her hand, jingling. She ignored the sound. "Hello, I'm back home." Hoped she'd get a reply and not find a note telling her to get her ass to Seattle Children's immediately due to some unexpected emergency. "We're here." Anne called back.

Ellis breathed in in relief. She took off her coat and shoes and walked into the living room.

Anne was sitting there, with little Meredith on her lap and feeding her carefully, the heart monitor sitting next to them on the couch, beeping steadily. "Were the any problems?" Ellis wanted to know. "No, no problems. But what I noticed was that she was ... her breathing was very laboured at some times, she turned blue a couple times - nothing big but I thought you should know. Anyways, I cooked dinner. There's still food for tomorrow, you can warm it up then."

"Oh, you didn't have to do all that." Ellis said gratefully. "Thanks, though."

"Not a problem at all."

Ellis eyed the bottle suspiciously. Meredith apparently hasn't drank that much. Damn it, this wasn't good. After they talked about payment, Ellis said bye to Anne. "You can call me if you need me to babysit again. I'm happy to do so." Anne said to Ellis. "And if I don't see her before her next procedure, good look. She's a fighter. She'll do it."

"Thanks." Ellis smiled softly. Then she left and Ellis walked into the living room, put Meredith back into her crib while getting her stethoscope. She wanted to check for abnormal breath sounds. She saw she had gained weight but she presumed it was due to edemas. She knew this was crazy but she just couldn't help it. Also, Meredith seemed lethargic and she seemed to have trouble breathing. She would have to take her to Seattle Children's to determine whether it's safe to wait with the surgery or not ... She can't decide that.

"Oh, no, this is not good." She murmured as she listening to her lungs.

Meredith was admitted three days before the actual procedure should take place so that they could perform the necessary exams before surgery to make sure they could plan the exact approach. But they also wanted her to stabilize while getting her pulmonary edema treated. Meredith's previous symptoms that started the night she went to visit Richard and Adele and they worsened so Ellis Grey decided to come in for a consult. She wouldn't take any chances. And it turned out, she had pulmonary edema caused by heart failure. They couldn't postpone/push the surgery anymore. They had to do it now. "We have to do the surgery now. We'll let her rest for two days and then we'll do the surgery." The cardiac surgeon said. Meredith was now three months old. Now the second and hopefully final surgery would take place.

He then put the transducer aside. He'd just performed the ECHO on Meredith.

"She's in florid heart failure. Her EF is falling precipitously." He then said. "What is her ejection fraction? Tell me, I want to know." Ellis insisted, breathing in deeply before exhaling.

This was hard, and it was about to get even harder.

"EF is 40 and falling."

"Oh, shit." Ellis exclaimed shocked. This was very bad. "There's pulmonary edema. We need to treat it, and see if we could get her EF up." The doctor said.

"We plan on performing an atrial switch invented by cardiac surgeon Senning. Due to the complicated relationship of the great arteries an Arterial Switch Operation is not an option, so the only options were: Atrial Switch Operation or Damus- Kaye- Stansel- Operation." He told her. Ellis glanced over to Meredith's bed. She was asleep and didn't know what was about to happen to her. Ellis was glad she didn't know, that she was so young.

If she was lucky, she'd never remember anything about this.

"So atrial switch it is?" Ellis shook her heart.

She knew that meant that her daughter was facing the risk of right-sided heart failure (that presents with left-sided heart failure symptoms) since her right ventricle was acting as the systemic ventricle. "Yeah, we're doing a Atrial Switch Surgery." He confirmed. Which meant that there was no way to correct the underlying defects of the heart. But since Meredith has no high grade sub-aortic stenosis, the surgeons tended to the other surgery: Atrial Switch Surgery.

At least that's what they told Ellis.

There's a perfect window - if you wait to long before doing the surgery it may be too late for a repair.

The next day, Ellis had spent the night at Meredith's bedside. She would have enough time for getting something to eat later on when they start to operate. They wanted to wait six months but they were doing it now because something had happened. And the pediatric cardiologist said that he'd want to schedule the surgery earlier to prevent new problems from forming.

"So we have to your daughter up to surgery now."

"But why?" Ellis couldn't understand. She wasn't thinking like a doctor, more like a terrified parent.

Because this girl was her child, her only child.

"You said you wanted to wait until she was six months old. She's three and a half months old. She's underweight, too small. Will she even survive this?" She wanted to know. The lead surgeon looked at her pitifully. "I can't promise anything. I hope she will. But I can't say for sure." He stammered slightly, while looking at her somberly.

"Right, you never promise someone a good outcome." Ellis muttered under her breath. Then they took her baby up to OR. She was standing there in the waiting room, ready to break down. But Ellis Grey didn't break down. So she put on a brave face and sat down, unmoving. But internally, she was screaming at he unfairness of the world. How could it be that her baby needs risky open heart surgery twice?

At some point, she just couldn't sit there any longer. She stood up and began to pace ...

During heart surgery, the anesthesiologist monitored Meredith's vital functions, including blood pressure, temperature, heart function and oxygen levels in the blood while the surgeons were performing the surgery. Alternatively an atrial switch by Mustard would be a different course of treatment. The only difference between Senning and Mustard is that by the Mustard-Method is used foreign material and Senning- Method use in reverse to atrial Switch by Mustard the patient's atrial tissue. But that was not the only option. The REV method (réparation à l'Étage ventriculaire), an intracardiac tunnel or Rastelli- operation would have been possible treatment options for a "double outlet right ventricle" with an sub aortic ventricular septal defect, but since Meredith's VSD was sub pulmonic these surgeries weren't a doable option.

In the atrial switch operation, the atrial tissue is cut so that the system venous blood passes through a so created pant shaped atrial tunnel and it gets into the pulmonary artery. The pulmonary vein blood flows past the tunnel in the right ventricle. Meredith' ventricular septal defect was closed with a tunnel patch that passes the blood from the left ventricle to the pulmonary artery. At the same time the AV Canal Defect has been fixed with the double patch technique. In the double-patch-technique cardiac surgeons closed the Ventricular septal defect and atrial septal defect with two different patches.

After VSD closure with the first patch the bridge sails of ASD were fixed with assignment to the ventricles at the patch, sewn the "cleft" and closed with a second patch.

This method is more complex than the single-patch technique. However, in this case the fragile AV valve tissue must not be incised. After they were finished with the whole procedure, the heart surgeons started to warm her up and let her heart beat on her own again but there was a problem. The heart-lung machine slowly stopped rotating. The surgeons were hoping that her heart would pick up where it left off and start beating but that wasn't the case. The lead surgeon also implanted an external pacemaker in case of arrhythmias. But that was just precaution and therefore only transiently and will be removed once she gets discharged. They weren't able to get her heart to beat on its own.

"Let's try again." The older and more experienced surgeon said. "Guys, she's getting unstable and harder to ventilate. If you're going to do something do it now, fast." The anesthesiologist interjected. After two failed attempts in taking her off cardiopulmonary bypass, the lead surgeon decided it was best to initiate ECMO, a modified form of CPB. "Damn it." He murmured.

"Let's initiate ECMO so that she has a shot."

He knew what that meant. Survival rates weren't very high in those cases.

"Ok, that's it, we're initiating ECMO." After hearing those words, the entire OR fell silent. The only beeping that that could be heard was the medical monitoring equipment. The lead surgeon looked at the oxygenation of his patient, sighing. The perfusonist asked since there are two types of ECMO: "What kind of ECMO seems apprioprate?" The pediatric heart surgeon looked up from the surgical field before answering: "Prepare for Veno-arterial (V-A) ECMO. That allows her lungs and heart to rest. Veno-venous (V-V) ECMO is used when the heart is functioning well and only the lungs need the support of the circuit."

Then he turned to his intern he is supposed to teach. The mother of the girl he was operating on almost freaked out at him when he told her that an intern would be observing the procedure. She didn't want any amateurs doing the surgery, she was the best – experienced surgeons operating on her daughter. "Have you ever hooked aa baby up to ECMO before?" He asked the intern standing there, watching the procedure. The intern only nodded, still shocked from what just happened.

"I hope you take notes because you're about to see your first ECMO that's being initiated in the operating room." The lead surgeon said, barely looking that the intern.

"But before we get started what is ECMO?" The young intern stuttered a bit before answering: "It provides … it … provides long-term breathing and heart support. Extracorporal membrane oxygenation is typically reserved as an extreme supportive measure when more conventional measures have failed. The baby can be on ECMO for days to weeks."

"Ok, enough with education. Let's get this show on the road. Preparing for ECMO."

"Are you ready?" They placed the cannulas connecting the patient to the ECMO circuit directly into the large blood vessels adjacent to the heart, similar to the connections made during open heart surgery. "Ok, now we have to connect the cannulas to the tubing." The surgeon announced. The cannulas were connected to the tubing of the ECMO machine and bypass circulation began. The lead surgeon heaved a sigh, knowing that he would have to tell the mother about what just happened in surgery. ECMO was initiated in the operating room immediately after her surgery to allow the heart to recover from surgery. "Ready to release clamps …" The lead surgeon announced, his eyes were on the cardiac monitor, looking for any changes in the oxygen levels. He was hopeful that this was the right approach even though it was very aggressive.

"Release clamps."

Then shortly after, the younger surgeon said, slowly releasing the arterial clamp while saying: "Arterial clamp off."

"Venous clamp off. Pump on." The lead surgeon said, hoping there would be an increase in oxygen saturation. The machine started whirr. All personnel looked at the monitor. After a seemingly very long minute, Meredith's pulse ox went up to 95%. That was definitely good.

"Starting to close up …" He informed, knowing there would be an increased risk of infection, renal failure and failure of the heart to recover adequately but it was worth a try. There was also the risk of bleeding. But he was also scared of Ellis Grey. Of telling her that her daughter was currently living because a machine has taken over heart and lung function for the time being. At least until she stabilized. "Let's get her to pediatric cardiac intensive care unit." He ordered as he left the operating room to scrub out. Now he had the ungrateful task to update the mother of this child.

... who was no other than Ellis Grey herself.

He'd heard about the first female surgeon starting her residency at Seattle Grace and now he just operated on her daughter. It was really freaking unbelievable, just as so many other things in life.

A/N: I hope you liked it ...

Here's some extra information about ECMO: Extracorporeal membrane oxygenation, or ECMO, is a treatment used for patients with life-threatening heart and/or lung problems. It provides long-term breathing and heart support and is used only when all of the standard treatments for those problems have already been tried. ECMO can support patients for days to weeks while doctors treat their underlying illness. It's used in treating infants with: Meconium aspiration syndrome (MAS), Persistent pulmonary hypertension of the newborn (PPHN), Congenital diaphragmatic hernia (CDH), Respiratory distress syndrome (RDS), Pneumonia and Congenital heart conditions. There are several forms of ECMO, the two most common of which are the veno-arterial (VA) and veno-venous (VV). In both modalities, blood drained from the venous system is oxygenated outside of the body. In VA ECMO, this blood is returned to the arterial system and in VV ECMO the blood is returned to the venous system. In VV ECMO, no cardiac support is provided (Source: CHOP)

Please review.