Finally finished with the brief press conference, Hunt made his way back to the ER, after ordering security to make sure that no reporters were allowed into the hospital.
"Karev!" Hunt called out. "Where's Grey? What is the status on the passengers?"
"Bailey took Mrs. West into surgery in OR 2, she had internal bleeding; Chang was able to pop Mr. West's shoulder back in without surgery; Sloan and Torres have Ms. Harris in OR 3; Robbins, Garrity, and Russell have Mr. Smith in OR 4, he has cardiac tamponade. You just missed Meredith, Mrs. West's injuries were more critical than Bailey expected and she sent for Meredith."
"What about the other three passengers? The baby?"
"The Webber, Carlson, and Nelson are still in surgery," answered Alex. "The baby is fine, no cuts or anything. We admitted her to Peds, at least until her family shows up, or Child Services. She had no injuries, seems like her car seat saved her life."
"Has Kepner had any contact yet?" asked Hunt writing down the names of the survivors and their conditions so that he could give it to Avery.
"She's talking with Shepherd now," replied Alex turning his attention to the news report of the crash. "She had to do some Burr holes on the pilot, and Shepherd is walking her through it."
"…The number of casualties is unknown. What we do know is that there were 20 people on board, including the pilot the small passenger airplane. A spokesperson from the airline informs us that the pilot made a distress call minutes prior to the crash. A representative from the National Transportation Safety Board has told us that the cause of the crash is still under investigation. All passengers are being transported to Seattle Grace Mercy West Hospital. Moments ago the Chief of Surgery, Dr. Owen Hunt, held a press conference stating that they had received passengers, but would not release their names, or how many had arrived…."
"So out of the 20, we have eight passengers here, Kepner is with the pilot, there are still 11 people unaccounted for."
"Hunt, we need an OR prepped and ready," said Shepherd walking over towards them. "Kepner did some Burr holes on the pilot out in the field, and he has a lot of other injuries. They are getting him out now and he should be here within the next half hour."
"Okay, go and scrub in. We'll have someone else take over the candyman. Ramsey can take of other traumas coming in."
"Oh my god! LEXIE!"
Owen, Alex, and Derek turned in alarm to the speaker, as did everyone else within hearing range.
"Kepner," Hunt spoke into the microphone, while turning down the volume of the speaker, so that only Karev, Shepherd, and himself could hear what April was saying. "What's going on?"
There was no response from April; all they could hear was labored breathing.
"Kepner, I need you to focus and tell me what is going on," said Hunt firmly trying to ease the uneasy felling in the pit of his stomach.
"I-I-I-It's L-Lexie," stuttered April. "Lexie is here."
"Kepner," said Derek, hoping that he heard April incorrectly, into the microphone pulling it out of Hunt's hand. "What do you mean by 'Lexie is here.'"
"It's Lexie. She is trapped beneath the wing of the plane."
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April was laying down on her stomach, trying to stay calm, and figure out a way to get Lexie out.
Okay. Okay. Stay calm. Stay calm… How am I suppose to stay calm when one of my best friends is lying underneath thousands of pounds of twisted metal… You need to know what is wrong with her.
"April, w-where's the b-baby?" asked Lexie, gasping for air.
"Baby? What baby?" April said confused, wondering why Lexie would be asking about a baby. Turning towards Paul, April directed her question to him. "Was there a baby on the plane?"
"Yes, the baby is fine, she should already be at Seattle Grace," Paul replied, continuing to assess the situation at hand. He knew that they had to move the wing off of her soon, or she would die.
"Dr. Hunt can you tell me if there was a baby that was taken to the hospital?" April spoke into her headset. She could hear Derek refusing to go into surgery, knowing that Lexie was trapped. Hearing no response, April once again repeated her question only louder. "Dr. Hunt! I need to know if there was a baby girl taken to the hospital from the crash site."
"Yes, we did have a baby girl brought in. She arrived a little bit after you left. She is fine; she had suffered no injuries. Dr. Kepner we need to know what Lexie's injuries are."
"Lexie the baby is fine," April grasped Lexie's right wrist to take her pulse. "She's already at the hospital, she didn't get hurt at all." April wondered why Lexie was asking about a baby, but she needed to concentrate on Lexie right now. "Lexie, I need you to tell me what your injuries are. I can't see anything or do much until they get this plane off of you."
"My legs and pelvis are crushed. And I can't f-feel my other arm, so I'm not sure if it's even there anymore. A-And, uh, my chest feels like its gonna explode, so it's probably a massive…hemothorax. I'm also bleeding internally…I've been coughing up blood for at least thirty minutes."
"April you need to get her fluids, and oxygen!" April heard Derek shout into her ear. "Get that plane off of her now or she is going to die!"
"You think that I don't know that!" yelled April, momentarily loosing her cool. Looking at Lexie, who was shivering from lying on the snow covered ground who knows how long, "Lex, you are going to be fine. We are going to get this thing off of you and get you to the hospital."
"April… I'm dying."
"What? No… you're not." April shook her head, turning around to grab the oxygen that one of the crewmembers had brought over from the helicopter. "Here, let me put this on you."
"April…" Lexie moved the mask off of her face with her good hand. "I'm dying. P-please tell Mer-Meredith… that she was a good…sister and… that I love her. Tell my dad…"
"Hey, hey, hey."
April wiped away Lexie's tears from her eyes, and the blood from her mouth. Placing the oxygen mask over Lexie's nose and mouth again. "You are not going to die. You are going to be fine. We are going to get you out of here and to the hospital. You are going to be Chief Resident next month, and you'll pass your boards next year, and you'll start your fellowship with Dr. Shepherd."
"Dr. Kepner."
April rolled onto her side to see Paul standing over her.
"I'm going to need you to step back," ordered Paul. "We cut off most of the wing, we can move it now."
April let out a sigh of relief as she rolled back onto her stomach to give Lexie the good news. "You hear that Lex, we are going to get this…."
April trailed off when she saw that Lexie no longer had her eyes open.
"Lex."
"Lex?"
"Lexie."
"LEXIE!"
"ALEXANDRA!"
April frantically started shaking Lexie and shouting her name. April could hear shouting in her ear, but it was all white noise, as was Paul calling out her name. Paul pulled April to her feet and away from Lexie as the crew began to lift the wing off of Lexie.
"KEPNER!"
"APRIL! Pull it together!"
"April, please! What is going on?"
April was snapped out of her thoughts when she saw that Paul had managed to pull Lexie out from underneath the wing, while the crew lifted it a few inches off the ground, just enough for Paul to pull Lexie out.
"Kepner!"
"They got her out," replied April running back to Lexie, who was moaning in pain, though she had passed out. "She's unconscious."
April bit back a gasp of horror at the sight of Lexie's left arm, she continued to exam Lexie's injuries.
"She's tachycardics, short of breath, she has several broken and fractured ribs, and her lips are starting to turn blue. Her left arm… it's really bad. Her pupils are dilating."
"You are going to have to put in a chest tube," said Hunt trying to calm Shepherd and Karev. "She more than likely has a pneumohemothorax."
"I don't think I have enough pain meds, or anesthetic," replied April, as she wrapped Lexie's left arm in gauze, especially near her shoulder. "It's going to hurt a lot."
"She'll die if you don't put in the chest tube!" shouted Karev.
"Alright, alright, alright." April grabbed some lidocaine, a scalpel, a chest tube, and any remaining sedatives and pain meds that she had, which weren't a lot. "I'm really, really, sorry about this Lexie."
April set up an IV with fluid administering the sedative, which lessen Lexie's pain, but only for a little bit. She tore Lexie's shirt open, and poured lidocaine all over Lexie's right side, where she had the least amount of broken ribs.
"Paul I'm going to need you to hold her down by her shoulders," April instructed Paul, before grabbing the chest tube and inserting it in between Lexie's ribs. Lexie's screams of pain were muffled by the oxygen mask, but they still made April cringe.
"We got it," April sighed in relief. "Her breathing is a bit better. We need to get her to the hospital now."
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"Tyler!" shouted Hunt turning off the speaker, now that April was on the helicopter with Lexie on her way to the hospital. "Page Dr. Bailey 911, tell her to scrub out of the surgery, and have Dr. Grey take the lead. Page Dr. Torres 911, as well, have Chang scrub in with Dr. Sloan instead. Have them meet us in Trauma room one."
"Shepherd, you can't scrub in on this surgery," Hunt told Derek once again. "You can't operate on your own family. Ramsey is going to scrub in on this surgery; you have to scrub in on the pilot's surgery."
"No," argued Derek shaking his head. "I'm not letting anyone else operate on Lexie. I don't care if you are the chief of surgery."
"Fine, you're in," agreed Hunt, knowing that this was not a fight that he was going to win. "But, if I feel that your personal feelings start to interfere with the surgery then I'm taking you out."
"Everyone is going to have a personal feelings," said Derek unemotionally.
"Karev your are in charge of the ER."
"Hunt what's the emergency?"
Bailey and Callie were looking at the grim looks on Derek, Hunt, and Alex's faces.
"Why did you page us 911?"
"Where's the patient?"
"Kepner is on her way back with the last survivor of the plane crash," started Hunt calmly. "The pilot is already here and Ramsey is going to operate on him."
"Is that why you called us here?" asked Bailey urging Hunt to get to the point. "You paged us 911 for the pilot?"
"No."
"It's for Lexie," interrupted Alex. "Lexie was on the plane and she was trapped underneath some of the wreckage. Kepner is on her way back with her. It doesn't look good."
"Does anyone else know?" asked Callie thinking about Mark and Meredith. Do they know that she was on the plane?
"Of course no one else knows," answered Alex.
"Nobody can let Meredith know until she is out of surgery," said Derek. "Or at least until another attending arrives to take over for her."
"How much longer is Meredith supposed to be?" Hunt directed his question to Bailey.
"About another two hours. We had to control the internal bleeding, and we were about to take out her spleen and part of her liver."
"Set up trauma room one. We'll be back soon. Do not let anybody into the trauma room, no nurses, residents or interns."
Alex, Callie, Bailey, nodded and hurried off, while Hunt and Derek grabbed trauma gowns and made their way onto the roof. The helicopter landed ten minutes after they had reached the roof.
"On my count!" shouted April holding onto the head of Lexie's stretcher. "One. Two. Three."
"Oh my god," gasped Derek seeing all the blood covering April's hands and scrub top.
"Alexandra Grey, 28-year old female, she was found pinned underneath a wing of the plane. She's tachycardic, short of breath; Dr. Kepner inserted a chest tube in the field," said the paramedic handing Lexie's chart to Hunt, to help April get Lexie's stretcher off of the helicopter.
"Lexie? Lexie can you hear me?" Derek asked shining his penlight into Lexie's eyes, as they headed down the elevator to the ER. "Her pupils are dilated. We need to get her stabilized and to CT as soon as possible."
"She's been in and out of conscious," stated April shakily putting pressure on Lexie's left arm. "She was mumbling something, but I couldn't hear over the sound of the helicopter."
"Kepner get a trauma gown and meet us in trauma room one," said Hunt when they arrived in the ER.
The ER had calmed down significantly, now that all the survivors were in their own rooms, or in surgery.
They had tried to keep the fact that Lexie Grey had been on the plane, but someone must have heard, because there were nurses, and residents standing around the ER, whispering hoping to get a glimpse of Lexie.
"EVERYBODY GET BACK TO WORK! NOT A WORD OF THIS TO DR. GREY!" Bailey shouted at the staff, before slamming the door shut.
"Karev see which OR is available," said Derek. "If there isn't any available see which surgeon can hold off their surgery."
"Karev call OR 3, Chang can close up for now," Hunt called out. "They can get Ms. Harris to the burn center."
"Kepner page Yang. Tell her we need as much O-neg as she can give us."
"She's losing a lot of blood," muttered Bailey noting the paleness of Lexie's skin as she moved the ultrasound over Lexie's abdomen. "She has a lot of internal bleeding."
"If you want me to save her arm we need to get her to the OR as soon as possible," said Callie examining the deep cut on Lexie's shoulder. Put more pressure gauze over the cut until they could get to the OR. "She's going to have a long road ahead of her, had the cut been any deeper or off to the side, it would've required an amputation."
"CT is ready."
"Okay let's move."
All of the machines that Lexie was connected to started beeping erratically.
"She's crashing!"
"Get a crash cart in here now!" shouted April starting compressions. One. Two. Three. Four. Five. One. Two. Three. Four. Five.
"Charge to 300!"
"Clear!"
One. Two. Three. Four. Five.
"Push one of Epi!"
"Charge to 300!"
"Clear!"
One. Two. Three. Four. Five. One. Two. Three. Four. Five.
Before Derek could defibrillate again the heart monitor let out an alarm, Lexie was asystolic.
"Come on Lex don't do this," whispered April continuing compressions, even though the muscle in her upper arms were starting to hurt from the repetitive movement.
Five minutes came and went with April doing compressions and Derek pumping the Ambu bag. Then five more minutes passed with no sign of Lexie responding.
"Kepner."
"No."
"Shepherd you have to stop." Hunt stepped forward placing his hand on Derek's forearm. "She's been down for over ten minutes, she's lost a lot of blood."
"No, this is Meredith's little sister, she's my little sister," snapped Derek shaking off Hunt's hand. "She is not dead."
Hunt looked over at Callie, Bailey, and Alex hoping that one of them would help him out.
"Derek stop please," pleaded Callie stepping to pull Derek away from Lexie.
"Do you want to be the one to tell Mark that Lexie is dead?" Derek asked pushing Callie back.
"WHAT?! WHAT'S GOING ON HERE? WHAT HAPPENED?"
Everyone turned in alarm to the person who shouted, except for Derek and April who were continuing CPR.
Mark was standing in the doorway with a look of shock on his face.
"What do you mean Lexie is dead?"
No one dared to say anything, not wanting to be the one to tell Mark that Lexie was currently lying on the gurney, bleeding.
"Someone answer me!"
Derek and April could practically feel Mark burning holes into their heads.
"Torres get Sloan out of here!" ordered Derek the frustration of the situation getting to him.
"I'm not going anywhere until someone tells me what is going on," argued Mark, watching the monitors, wishing that if he kept staring at them long enough that they would start beeping again.
Dropping the Ambu bag, Derek shoved away April's hands before slamming his fist down, hard, on Lexie's chest.
Beep...
Beep…
"She's in V-fib. Quick push one of epi!" yelled Hunt grabbing the paddles and pushing Derek aside. "Charge to 360! Clear!"
Everyone held their breath, staring at the monitor that had beeped once and then twice. Beep… Beep… Beep… Beep…Beep…
"She's back," exclaimed Bailey.
April sighed in relief letting out a small laugh of joy.
"We need to get her to CT stat."
"Karev stay with Sloan, do not let him in that OR."
"Kepner you stay here and page us the minute that Meredith gets out of surgery."
"I'm going with you," insisted Mark walking around Alex to grab Lexie's hand. "Please, Derek. I need to be with her. Lex, I'm right here. I'm not going anywhere. Do you hear me?"
Hunt not wanting to waste any more time agreed.
"Fine, but you stay in the gallery. Karev make sure that he does not step so much as a foot in that OR. If he makes any move to enter that ER, you tackle him. Let's go."
Callie went with Alex and Mark, while Bailey headed to CT with Derek and Hunt.
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An hour later Meredith was on her way to the ER. She had been pulled out of surgery by Dr. Kent, who told her that April was looking for her. She spotted April standing at the ER desk talking on the phone.
"…Need the names of those on the plane," Meredith heard April tell whoever was one the other end. "We need to contact family members, but we can't do that until we have the official list of everyone that was on that plane. Okay. Thank you."
"Still no list of the crash victims yet," said Meredith scaring April, who had not seen or heard her.
"Yeah," replied April rubbing her temples. "They are barely going to fax over the list of people that were on that flight. Apparently they were waiting for their lawyers or some legal type of thing before they sent it over."
"Dr. Kent said that you were asking for me. Why didn't you just page me?'
"I needed for another attending to arrive to take over the surgery," explained April.
"Why would you wait for another surgeon to take over for me? I'm almost an attending, I could handle the surgery without an attending."
"Meredith," April took a deep breath. "Lexie was in the plane crash. She sustained a lot of injuries. Hunt, Shepherd, Bailey, and Torres are operating on her right now."
April saw the blood leave Meredith's face at the thought that her sister had been in a plane crash.
"Where is she?" asked Meredith spinning around, as if hoping that Lexie would appear out of thin air. "Where's my sister?"
"She's in the OR right now, they had to go in quick to stop the bleeding."
"What OR?"
"Meredith you can't go in there," April ran after Meredith, who was halfway to the elevators. "You can't go into the OR. They won't let you in, they said that you could wait in the OR gallery."
"What OR Kepner?" Meredith asked again pushing the button for the elevator impatiently.
"OR 3."
Screw the elevator. Meredith took off running for the stairs. April was about to go after her, when Tyler called out her name.
"Dr. Kepner! The airline sent the list of names."
"Uh, thank you Tyler," April thanked Tyler taking the list. "Can you please page Dr. Yang to the OR 3 gallery."
April shoved the list into her pocket, running onto the elevator, that had finally arrived.
Making her way into the gallery, April saw Mark sitting down in one of the chairs, gripping Meredith's left hand tightly. Meredith had her right hand gripping Alex's left hand.
"How's she doing?" whispered April to Alex.
"Stable," answered Alex, without his usual attitude. "She had a pneumohemothorax. Hunt and Bailey had to take out her spleen, and they are trying to save her liver. Torres is working on repairing her arm, and Shepherd found a bleed in her brain."
Sighing in relief that Lexie was stable, but worried that Lexie had suffered a lot of trauma, April sat down in the chair behind Meredith. April pulled the list from her pocket along with her phone, to text Jackson to get to the OR, so that he could give some information to the families.
Pilot: William Tanner- 40, E.C. (Emergency Contact)- wife. Passengers: Gomez, Sarah- 37 years old, E.C.-husband, David. Williams, Nick- 31 years old, E.C.-brother Josh Williams. Grey, Alexandra Caroline, 28 years old, E.C. –Sister, Meredith Grey-Shepherd.
April continued scanning the names of the passengers, holding back tears, seeing that there were two other kids on the plane. When she got to the bottom of the list she was unable to hold back the gasp of shock that escaped her.
"April." Meredith turned to April, seeing a look of complete shock on her face. "April, what's wrong?"
April didn't answer Meredith she had been reading the same line over and over again thinking that if she read it over enough times then it would make since.
"Kepner."
At the very bottom of the list read: Grey, Samantha Claire, infant, traveling with mother Alexandra Caroline Grey, E.C. aunt-Meredith Grey-Shepherd.
