Chapter 3
As doctors, we know everybody's secrets. Their medical histories. Sexual histories. Confidential information that is as essential to a surgeon as a ten-blade, and every bit as dangerous. We keep secrets, we have to, but not all secrets can be kept. In some ways, betrayal is inevitable. When our bodies betray us, surgery is often the key to recovery. When we betray each other... When we betray each other, the path to recovery is less clear. We do whatever it takes to rebuild the trust that was lost. And then there are some wounds, some betrayal that are so deep, so profound that there is no way to repair what was lost. And when that happens, there's nothing left to do but wait. Cristina Yang; From A Whisper To A Scream
Meredith stood in front of the sink in the scrub room and tried to calm herself down. Through the windows she saw Bailey was continuing the surgery. She was breathing heavily. Her freaking past caught up with her again. Damn it. She did not deserve this. She did not deserve any of this but somehow it was her who has to live with this. Nobody deserved living like this. Meredith wanted to wake up from the current nightmare she was facing. But this, she can't wake up from this because this is the reality, her past has catched up with her, once again threatening to make her life a living hell. She'd been fine the whole way through med school and college. Her heart had been fine. Some people say there is no way of actually knowing that it's fine if they don't do the tests to prove this. But she had a way of feeling whether she was okay or not. And now, right now, she was not. She just left an operating room, fleeing like Bambi from a bushfire. Yet here she was, running along the hallways, passing nurses, doctors and other orderlies just to bump into Cristina.
"Meredith?" Cristina scrunched her nose. She'd never seen Meredith like this before. Meredith was collected and calm in almost every situation, she did not panic easily. But not right now. Right now she was just not herself.
"Wait up." Cristina called.
Something happened, must have happened to send Meredith in this state. Meredith came to a sudden halt. She glanced over to Cristina and walked onwards. Cristina was confused.
"Mer, what are you doing, why are you …"
She followed Meredith, there was no way she would leave her alone like this. Meredith on the other hand tried to get to the basement without anybody seeing her which was senseless 'cause she already had Cristina following her to the basement, because that's where the interns spent the night shifts, when nothing was going on.
"Hey, I'm scrubbing in on a valvular aortic stenosis. That is so impressive. Are you jealous? I, Cristina Yang, am scrubbing in on an open heart surgery. God, I love, love, love cardio. I am addicted to it." She gushed enthusiastically.
Or more like bragging. But that was okay when you consider the fact that she's good at her job just as she is.
Meredith tried to listen to her friend but she couldn't quite focus on the conversation. Her head was occupied with things. "Good that your boyfriend is a cardiac surgeon." Meredith chuckled, allowing herself to think about anything else just not this. And for me too, if I need another surgery on my heart, then he is the one to do it, she thought to herself, adding silently. "Right, it is really ... really ... amazing. God, I am so happy right now. A whole day in the OR, that must be heaven." She said still overly euphoric. But then ... Meredith did not have time to react, even less to say something coherent. She opened her mouth: "That's gre ..." She was cut off by Cristina Yang who stared at her friend with a shocked look on her face. She finally got a grasp on what's going on with her friend. And that was a shock, an unimaginable shock for her. Her blood ran cold as she realized what this means. "Mer …" She whispered hoarsely.
"Cristina, don't. Just don't." Meredith warned her silently.
She stared at her in shock. She couldn't describe it with other words. Meredith did not look very good. She noticed the lack of color in his face, the lack of normal, healthy color. Her face was pale but not only that. It was also cyanotic. But then her eyes fell on Meredith. Her surgery was forgotten instantly. This was way more important.
"Oh for my ever loving God, is that..." Cristina asked shell-shocked.
No, what the heck is happening here? That cannot be true. Meredith is cyanotic. That is a fact. She is looking right at her and this is definitely central cyanosis, the kind of cyanosis caused by congenital heart defects and pulmonary deficits. She knew that since her boyfriend was cardiac surgeon who treats those conditions. She was at her loss of words and that literally did not happen often. But right now it did. Cristina grasped her friend's wrist and held her so that she couldn't get away. Meredith avoided her pressing stare. She knew Cristina would not back down. Not on this, anyway. "That is cyanosis. You are cyanotic, Meredith. Do you have a congenital heart disease? Did you have had open heart surgery? I mean, because that is cyanosis and cyanosis often occurs if you have a CHD or are you ... chronic cyanotic?" Cristina rambled, looking at all possible conclusions and jumping to worst-case scenarios.
Meredith did not answer.
She knew she could tell her and she would be all supportive but she just couldn't bring herself over to do this. There was a chance that Meredith was sick. A real one. And by the looks of her actions she took Bailey nor Webber know about it.
Meredith hasn't replied. She has not said anything ever since the confrontation. "Meredith? Say something, please. Tell me what is going on." Cristina urged suddenly fully alert.
"I'm …" Meredith started.
Cristina looked hopeful but in the end Meredith completed the sentence with: "I'm fine." Typical Mer – avoiding problems until not possible anymore.
"Mer? Is everything all right? Or you have a cardiac problem that I don´t of, because you´ve failed to tell me? I mean, you're turning blue. You are cyanotic. You can't tell me you're not. I know you think you're untouchable but … everyone has problems. We all have them and there is no shame into admitting you have a problem." Meredith couldn't do this, dragging Cristina into her crap, this was not fair to her. She already annoyed her with all her boyfriend-problems.
She was sure she was a burden to everyone she cares for and so she just shuts up about it. She couldn't shake the feeling to feel worthless, another aspect she hated. She wasn't untouchable and they all knew it.
"Cristina, I can't tell you. I'm sorry, but I ..." Meredith stopped abruptly because at the moment Cristinas pager shrieked. Once again, she was saved by an emergency. Cristina shot her a glare, "We're not done talking about this. I am not letting this go. You are my person and I care about you. You can come to me with any problem." She said warmly, it wasn't often that Cristina Yang showed emotions openly. It was Dr. Burke who paged her. The valvular aortic stenosis correction on an eight year old boy, she was supposed to scrub in on this surgery. Due all the worry about her person she totally forgot that she was scrubbing in on Burke's surgery: the pediatric heart patient with the leaking aortic valve.
Speaking of pediatric heart patient, if Meredith had one too, she was a pediatric cardiac patient and an ACHD patient who needs to be seen regularly from a specialist that is specialized on treating adults with congenital heart defects. Her thoughts were racing and she couldn't get them to stop. "You know, I gotta go. Will you tell what's going on with you when you can?" She said after looking at her pager.
"When you are ready to face this. This is not going away Meredith, as much as you want it to but it's not happening."
With that Cristina left.
"Have fun." Meredith called after her retreating back, Cristina didn't even know if Meredith registered the question she has been asking her. Cristina knew nothing of what was going on. How could she possibly know or even imagine what was going on? But eventually she would find out anyway. Meredith sighed as she watched Cristina go. She has to tell her, she is the only one she really trusts and she knows she can rely on her, that she is reliable and trustworthy. She can depend on her. Cristina is her person. And Meredith is Cristina's person. Cristina remembered everything she had seen. Meredith had been blue. Only slightly, but she had been blue. She was cyanotic. Damn, Cristina Yang ranted lost in thought, as she walked through the hospital corridors, knowing anything's wrong with Meredith, who she referred to as her person.
Her only person.
She needs her person to be alive, breathing. She makes her brave. Cyanosis is common symptom in many congenital heart defects. She couldn´t be sick, could she? She is Meredith. And Meredith is always fine. She is fine no matter what ... But what if she wasn't? She is queen of saying everything's fine, even if she's not. Mer did not have a cardiac thing going on.
Or has she?
She absolutely had talk about it with Meredith, because there was definitely something that they do not know. Meredith Grey had a secret. She kept her medical history a secret. 'bout her medical history. For some reason she had not told Cristina. What was weird 'cause she has told her everything about McDreamy and McWife. If only she knew what was going on. She just hoped it was not what they thought it was ... One thing was clear: Meredith should get examined by a doctor. She really should. This could end badly, potentially badly.
But it was bad either way.
Cristina was worried, seriously worried. This was not some kind of boyfriend problem, it was something much more bigger and even more dangerous and dark and probably more difficult to deal with, especially congenital heart defects. But, she did not even know if it was one.
She was leaning against the railing of the catwalk, not seeing Burke coming up to her. He put a hand on her shoulder. Cristina flinched, obviously taken by surprise.
"Is everything on track?" Burke asked, his eyes sparkled as he spoke. But Cristina could barely concentrate. Meredith was occupying her mind. "Yep, of course. Why shouldn't it be?" Cristina finally found her answer after some seconds went by.
Burke's brows furrowed. "You ready for surgery? OR 5, 17:00 PM." He reminded her.
Cristina nodded in reply as she was just lookin' out of the panorama windows, trying to picture this. "I was just … have you seen Meredith today? She was acting weird, and I noticed something. Anyway, it's probably nothing." Cristina relented, not wanting to do this to Mer. It was her person and she was the one to figure it out. "If so, then we have a patient who needs to be taken to pre-op now." Burke ordered her, back into surgeon-mode, superior-mode. Since he was the one in charge of her. He was the attending. "Let's go." He said as he walked over the catwalk, toward the patient room. Cristina was following him only a bit slower so she did not notice him talking to her.
"Dr. Yang?" Dr. Burke's voice brought the young medical assistant back to reality. Cristina snapped out of her thoughts as she and Burke kept on walking through the hospital hallways. "Yes, Dr. Burke. I was distracted." She apologized quickly towards the world-class cardiothoracic surgeon. "So I've noticed." He simply replied, thankfully he did not add anything.
Cristina hinted a smile to express her gratitude and Burke nodded almost imperceptibly.
Then he entered the patient's room, Yang was right behind him. "Hello, Mrs. Lewis, hello Ryan, ready for surgery?" He directed to the mother and the patient he was going to cut open. "Where is your husband?!" Burke asked friendly. "He's downstairs getting coffee for us. He'll be back in a minute." The woman explained. "Yang, present." He said, handing Cristina the patient's medical record. This, the intern opened and took a quick glance at it, skimming over the information and medical history of the boy in question. "Of course, Dr. Burke." Cristina quickly said and started to present the case. "Ryan Lewis, eight years, he was diagnosed with valvular aortic stenosis. He is in for an open heart procedure to repair his hear. We're going to use the cardiopulmonary bypass to bypass the His values are good, the chest X-ray showed no acute progress." Cristina finished presenting the boy´s case.
"Okay ..." the mother began, "What does that mean for us now?" Her voice was uncertain. Dr. Burke looked expectantly toward Cristina and gave her a slight, but noticeable sign that she should continue with explaining. "That means we are operating Ryan today." The mother nodded and stroked her son's hair soothingly.
"Dr. Yang will prepare him for surgery." Dr. Burke gave the command.
"Of course, I will prep this little boy for surgery so that we can get his heart fixed." Cristina gave in, doing the job she was here for and grabbed the medical record.
"I am not little." The boy replied loudly, when he heard Cristina.
"You so are." Cristina laughed. Burke looked at her in disapproval. Cristina noted it and she also saw the boy's features. The boy frowned and looked like he was about to cry, "I am sorry." Cristina apologized. "I did not mean to offend you. But you are a little boy." "I am not." This time Cristina didn´t answer, she had different things playing on her mind, more important things than discussing with a nine or eight year old patient. Burke gave them a smile and said: "Please excuse Dr. Yang and her behavior. I can assure you that this intern is the one you want to have on this case, she might be bold in language but she's skilled. We're going to do our very best work. "Thanks." The mother said and breathed in deeply.
She smiled at the two shortly.
She followed Dr. Burke outside the patient's room and then faced him. He kind of had a serious and attentive look on his expression. "Cristina. Your bedside manner needs work, definitely. Cut the boy some slack, he is about to undergo major open heart surgery." Cristina rolled her eyes but Preston frowned. Cristina sighed and said: "Yes, Dr. Burke, I will work on that." She reassured him that she will really so it. In this moment, a man with two coffee cups was walking toward Ryan's room.
Flashback: Meredith, six days
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. 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.
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. 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; 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?" "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. "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 causes 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. 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."
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 (JET) occurs in the hospital with rapid hemodynamic instability, whereas congenital JET may have a more insidious course before producing signs of congestive heart failure. The doctors also noticed a decreased cardiac output. They suspected she is suffering from one dreaded postoperative complications after correction of congenital heart fault. 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.
Patients with congenital JET present with moderate tachycardia and signs of congestive heart failure. 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.
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, in rare cases they also do a heart catherization.
The most important test is in all forms of JET the electrocardiogram. Meredith's ECG showed that the QRS morphology is similar to sinus or atrial-conducted beats. The ventricular rate wasn't equal to the atrial rate which is usually the case in junctional rhythm with 1:1 retrograde VA conduction. An irregular ventricular rate could be observed on her electrocardiogram and that happens when appropriately timed atrial impulses conduct to the ventricles. That means it is a junctional rhythm with retrograde VA dissociation.
Also, there was a "warm-up" pattern, usually the arrhythmia starts gradually. An exception to the last 2 patterns described above rarely occurs, when both JET and complete heart block are present. Meredith showed frequences of 300 beats / per minute, that is way too much.
Soon, Meredith was diagnosed with that life-threatening condition.
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 JET (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 oedema because the amount of fluid build-up wasn´t causing any good. 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 JET wasn't easy to deal with.
Meredith, meanwhile, had herself holed up in the basement. Cyanosis. That could not be true. Just now, during her time as an intern – she was royally screwed and of course it was her who was screwed. It's always been her. Why should it change now? She was afraid that the truth will come out. But Meredith knew that at some point everyone would know anyway. "No." she grumbled angrily to herself. Why did it have to start again? Life is not fair. It just will not stop throwing all this crap on her. She was tired of that, so so tired of all this freaking crap. She was now an intern, now isn´t the right time and place of it to start again and making her life a living hell. Why is it always her? Just and only Meredith Grey, magnet for all crap things.
"That cannot be true." She could not believe any of it, that everything went off again. It had to be a nightmare, a frigging nightmare that is going to haunt her Again and Again. Over and Over. This circle would never ever end. Meredith repeated it in a flat, disbelieving tone, ranting: "This cannot be true. I hate it, hate it. This isn't supposed to be like this. It isn't fair. Why is it always, always, always me? God, I don't want it anymore." In the quiet hallways was nobody who could hear her. No human beings were here, only some empty beds but beds can´t talk or hear or anything like that. She did not want to be operated on again. She didn't want to be the person on the table. Three times was more than enough. Meredith does not want to add a fourth time to it.
Meredith is desperately trying to ignore the fact that no one knows what is wrong with her, well, she chose that no one knows. She didn't have a problem, she assured herself, knowing that she was wrong. She avoids, and ignores and denies that she has a significant medical problem but it ultimately does not work, at least not in the long row.
The truth will come out at some point.
The first surgery was a pulmonary artery banding and the correction of interrupted aortic arch six days after her date of birth, in order to stabilize her first and the next surgery, the so-called atrial switch by Mustard or Senning came after three months, and the third surgery was the one where they corrected the Right Ventricle Outflow Tract Obstruction at the age of five years. Meredith tried not to think about it, but she thought about it anyway.
She knew it. She knew she has to go to a cardiologist specialized on treating adults who were born with a heart defect, to leave clarify the cyanosis. But she wasn't able to. Sure, she could ask Cristina if she would do it. Cristina could perform an echocardiography all by herself, Dr. Burke trained her well.
But that means she has to tell her, but that is easier said than done ...
Everyone would stare at her, and that she couldn't take. She just did not want to. Maybe they expect her to be forthright with her health. But does that matter? She still preferred people not knowing about her medical condition. But for the first time she began to question whether this was a good decision or not.
Well, she could perform a cardiac echo on herself, but, however, it's difficult to perform this on her own heart.
You would not get it right with the different views. Or Burke could. No, he couldn´t, because then everybody would know. Dr. Miranda Bailey, her superior and the Chief of surgery would know it by then. And then everything would be different. She was aware of what people still thought. It was either that or the other one, a lot of times it was this way, they were viewed one of two ways and that sucks. It does. Meredith knows that from experience, sadly. She'd been dealing with this her whole life. People are either sick or healed. Dying, or cured. There is no middle ground, no adaptation. Except for some people, there was middle ground. She was one of those people. But Meredith was constantly trying to adapt to her current situation, day after day, not knowing what the next day will bring, she is constantly adapting to whatever her body is doing at any given moment. She is trying to learn how to live. She can't tell them, can she?
They would act differently and look at her differently even if they are physicians, because that is a normal reaction when people discover she is different from them. She wants them to act normal.
Damn, why does this have to be so difficult? She took a ragged breath.
And in top of that she was an intern and interns could not simply take time to go to the doctor. Interns practically live in the Hospital with all the night shifts and the trolling for interesting cases. Restless, she ran into the hallway and down the next available beds. She had to think. This could not go on like this. She would probably get into trouble if nobody knows. Meredith buried her head in her hands and for a moment, she felt like giving in and crying. She was alone, her chest heaved with every breath she took. She felt like everything she knew slipped away, just like that.
She had to tell someone. Eventually, it would come out anyway. Why not tell Cristina Yang. She was her person. But then it occurred to her. She had forgotten one person. One very important person. He was very important to her. He showed her feelings that she didn't know existed.
Derek.
She could not tell him. He would be worried sick about her if he knew about her medical condition. But that was normal, right? She'd never done this before and if she was honest, it kind of scares the crap out of her. Little did she know that he already suspected something was wrong due to her actions this morning – well she did not forget that what happened then. So she would just tell Cristina who was her Person.
And she wouldn't tell anyone except her when she is ready for it.
Cristina just finished her surgery with Dr. Burke. "Okay, we're about ..." He said as he put in the staples by using the stapler. She was watching him as they closed the patient up. "Cristina?" He stopped her as she was leaving the scrub room quickly. "Yes, what? I need to talk to Meredith. It's urgent." She said sounding stressed. "Wait. Cristina. Wait." Burke said, holding her back. Cristina turned and faced him. "What is it?" She asked. "I have a thing to do." She added. "I know that you're usually much more attentive." Dr. Burke looked at Cristina. She saw that he was worried.
But he shouldn't be, he should rather do a cardiac echo on Meredith ...
But she didn't say anything. She wouldn't do that to Mer who trusted her. Cristina looked puzzled, and then stuttered with a slight grin: "No, no, I..." She stopped. But then Cristina shook her head. "You know, that's just stupid. I'm leaving now. I have no time for something like that, really." Cristina Yang turned around and left Burke standing in the scrub room. Dr. Burke watched her go skeptically. That was not Cristina Yang, he knew. Something was going on.
The Cristina, who he knew was enthusiastic about all possible cardiac procedures. But today she had been distracted. So much had been pretty obvious throughout the surgery.
Dr. Bailey on the other hand just finished her procedure and was on her way to find Meredith to talk to her about what happened in there. She walked through the hallways and promptly, she was running into a charming surgeon who was tall and likes to lean against things, plus he is obsessed with his hair. Anyway, that is not the point. "Shepherd, it's a good thing I ran into you." "Dr. Bailey, in a hurry as always." Derek said as he smirked. But Miranda Bailey did not have the time for the McDreamy show. She needed to find Grey. "Shut it, Shepherd. I have no time for this." "You know I am your boss?" Derek asked, blinking in confusion.
"That I am aware off. But you don't scare me." Bailey huffed.
Derek stopped. "Do you need anything?" He then asked.
"Do you know by any chance where your girlfriend is?" Bailey asked him sighing. Derek shook his head. "Is everything okay with her?" He then asked, remembering the meds from this morning, a not so good feeling ran through his body, instantly he started worrying.
"Honestly?" Miranda Bailey asked with a frown covering her features. "I think she is not telling us everything." "Telling us everything about what?" Derek asked concerned. He had some idea what this was about but …
"Her medical history, Derek." Bailey let out a sigh.
"Do you know where she is? She just ran out of my OR with what seemed like troubled breathing. I tried to convince her into paging Burke but she wouldn't let me." Bailey sighed. Sometimes, it seemed like she had more trouble with her colleagues than her patients. Meredith dating Derek, McWife showing up in Seattle out of blue, Cristina collapsing due to an ectopic pregnancy, Meredith almost getting blown up by a bomb in a body cavity, Meredith in need of an appendectomy, Izzie cutting LVAD wires and quitting the job in the aftermath after stealing a heart for him who dies after getting that heart, the prom sex with Derek (Bailey knew whose panties where on the bulletin board even though Callie covered for Meredith) – and now this: a potential cardiac thing going on with Meredith.
It was always them, it was always her interns. Derek stared at her. "No, I don't …" He exhaled slowly, trying to think of what to say. "I don't know where she is. I'm sorry …" In this moment, his pager beeped, interrupting the conversation.
"I have to go, my patient's crashing." He said before running off toward the patient room.
Meanwhile, Bailey wasn't the only searching for Meredith. Cristina ran through the corridors, in the hope of meeting Meredith Grey. Instead of meeting Mer she met Izzie and George, whose shift started in five minutes. She groaned inwardly. This was exactly what she did (not) need. Izzie Stevens smiled perkily at her. George seemed more tired and not in talking mood. "Hey, Cristina." Izzie called cheerfully. She was always cheerful. "Iz." Cristina replied in her typical for voice. "I didn't expected you here." She added flatly. Izzie frowned. "We're here to do our jobs. Being a doctor and all." She said.
Izzie looked at her funny. George watched them. "Cristina, is everything okay? You seem a bit off and you're acting weird." Izzie noted something was off about this. Izzie wanted to know who noticed Cristinas somewhat worried expression. Cristina turned around and said, shaking her head: "Yes, sure. What did you think?"
Izzie took a sip of coffee and then said: "Have you seen yourself? You look like you've seen a ghost..."
Izzie made hand movements. "Izzie." George hissed softly he stands next to her. She turned around and said soothingly. "What´s the matter? I was just ..." "I have to go. It was nice talking to you but I really have to go," Cristina said and disappeared over the catwalk. Then she thought of the basement. It where the interns spend their free time between surgery and patient care. Finally Cristina had found Meredith. She had been in the basement. As Cristina echoed footsteps in the corridor, Meredith turned around, obviously startled by Cristina's sudden appearance.
Instantly, her breathing quickened and she struggled catching her breath for a few seconds. That was not good. This was not good at all. After a few seconds, Meredith calmed down and her breathing slowed down noticeably.
"Meredith." She spoke.
Cistina watched the scene concerned. Meredith walked over to one of the gurneys and let herself fall onto them. She turned away from Cristina. Cristina followed her friend a bit further and sat down as well. She eyed Meredith for a moment before started to speak. Cristina's back was leaned aganst the wall and Meredith desperately avoided to look at her.
"Mer." Cristina said quietly, but with a strong voice. "What was that?" Meredith looked at her friend confused and then said: "What was what? What ... what do you mean?" It was better to pretend everything was alright even if it wasn't. Cristina looked at her friend in disbelief. "You know exactly what I mean." Meredith should have known that Cristina would not let go. Cristina knew Meredith wasn't good at keeping secrets. She would cave eventually.
Meredith looked at her innocently and decided to pretend she didn't what Cristina was talking about. "No, I do not know." She argued. Cristina saw her in person punitive.
"The shortness of breath and cyanosis? Dammit, Meredith, you're a goddamn doctor, so please behave that way. It's for your health, not mine. And I do care about you, because you are my Person- the best friend I've ever had and you´re too risky with your health. If something's wrong with your heart, you have to be careful and you definitely should go see a doctor about whole ´Your face is turning blue´-thing, you now?" Cristina Yang finished her lecture.
Meredith looked down. Finally she said: "But it's nothing, I'm fine ..."
She lied.
Cristina shook her head firmly. "No. You're not fine, I can see that. You're anything but fine. I can tell." She said resolutely. "You're lying to yourself. You're definitely not okay. Something is not right. I know you well enough to know that."
Cristina looked at Meredith and continued: "... Come on, Meredith. Tell me what's going on and I'll schedule an appointment with Dr. Burke for you. I'll even make him swear that he keeps his mouth shut, but go see a freaking doctor." Meredith rigorously shook her head. "But why not? You need someone to check it out." Cristina tried to get her to understand. Meredith still has not said anything that resembles words and sentences you could understand. There is absolutely no way she would undergo here at Seattle Grace an examination. As of then half the Hospital would know after a day that she had been here as a patient. There was no way something concerning the staff of the Seattle Grace Hospital could be kept a secret, furthermore, she was a magnet for the gossipy crap starting with her relationship with Dr. McDreamy. Because of those chatty nurses, who love gossiping. You could also say that it's that what they do if they have nothing to do. Okay, that mean, but the nurses really are chatty. And thus the questions. No way.
There was no way she will go through that as well.
"Meredith?" Cristina's voice sounded slightly fearful, as Meredith looked away and said nothing. Suddenly Meredith raised her head and looked Cristina straight into the eyes. "No," Meredith said quietly. Her voice trembled slightly. "Uhuh, you don't get away with this. I won't let you 'cause I care about you. I know you have these trust issues but I am me, I am Cristina, your person as I am sure you know but the point is, Meredith, you're not in this alone. You are not. You may feel like you are with your mother being in a home and all but you're not." Cristina wasn't about to give up on her.
"Well, I am. I've been dealing with this for years and years and years and I've accepted that. I have been dealing with this for the majority of my life, in fact in birth." Damn, maybe she'd said to much. Way too much information.
"So, what is it?" Cristina asked, bluntly as she looked Meredith straight in the face.
She was growing worried about her because something was as sure as hell not right. There was something - medically - going on with her and she just can't seem to pinpoint it. As much as she wanted to, she can't and Mer won't tell anything. "I am not saying anything." Meredith was stubborn and intended on not telling anything about what is going on with her. Cristina shook her head in irritation. There was something.
"Mer, this becoming ridiculous, I wanna help you and you won't let me, no. You'll get your heart examined, even if I have to kick your butt all the way to get you there." Meredith was silent. Then: "Why are you so sure it's my heart?" She asked. "It doesn't matter how I know or what I know. Fact is, you need to get checked out, Mer. I mean it. This isn't normal."
"So what is normal?" Meredith shot back furiously.
"Normal as in healthy, Meredith. And cyanosis isn't something that indicates anything good." Cristina said, sighing. "Look, I want to help you, I really do but I can't if you don't let me in."
She did not know whether she should Cristina tell about it or not. Should she tell her 'bout the fact that she was born with a heart defect, that she´d to have open heart surgeries in order to have a shot at living. Sure, if Cristina knew, she would drag her to Dr. Burke to get her heart examined and Dr. Webber and Dr. Bailey would know. No, that was absolutely impossible. Meredith didn't know what would happen then. Perhaps they would even throw her out the program. It could be.
She cannot risk getting kicked out of the surgical program. It was her life besides spending time with Derek and Cristina. It would make her ordinary, a failure. She wouldn't have that. "Cristina, we talk about it tomorrow." Meredith decided. "No, Grey. We talk about it now." Cristina disagreed sharply and pushed an unruly black curl away from her face. "Bye, Cristina. I still have to check on some of my patients." Meredith said smiling. "You cannot just leave now. This is your health, Mer." Cristina exclaimed dumbfounded. "You know what? Have it your way. It is your life, not mine. I am here for you if you need me or want to tell me." Cristina decided to give it one (last) try. You don't leave the people alone you care about.
She won't do it to Meredith. Not now. Not in her situation.
Out of the blue, Meredith felt the need to go to Joe's and do some shots to drown her sorrows but In this case, she doubted that she would feel less crappy afterward. Alcohol wasn't going so well with her system right now. Not with her heart not doing what it should do. It would put too much strain on it. So she wouldn't, couldn't do this.
"As you see, I can." Meredith replied and went away. "And I will." "No, you will not, because we are definitely not done talking, Meredith." Cristina called after her with a worried expression on her face. But Meredith acted like she didn´t heard her and soon disappeared out of Cristina´s sight. Cristina sighed and let herself fall on one of the beds in the empty hallway.
If that goes well ... Well, she could only hope. It's all she can do for now.
A/N: Here is some information about the heart defects I have mentioned earlier in my text.
Let´s start with Taussig- Bing Anomaly: The Taussig-Bing complex is a very rare special form of TGA (a partial TGA). The aorta arises from the right ventricle and the pulmonary artery "rides" on a ventricular septal defect and receives blood from both ventricles. The venous blood from the systemic circulation flows through the right atrium into the right ventricle, into the aorta and is transferred to the systemic circulation. The oxygenated blood from the lungs flows through the left atrium into the left ventricle and then to the larger part of "riding" through the pulmonary artery (the so connection both to the right as the left ventricle has) back to the lungs and to a lesser extent by the ventricular septal defect into the right ventricle and then through the aorta into the systemic circulation. The result is an overload of both the lungs and the right heart, which can lead to the failure of both organs. Often associated with coarctation of the Aorta and interrupted aortic arch.
Then I´ve mentioned a heart defect called AV Canal Defect. It means there is only one atrioventricular valve (normally there are two: tricuspid and mitral valve), lengthening of the left ventricular outflow tract, not restrictive ventricular septal defect (large hole between the chamber) and atrial septal defect (hole in the atrial Septum). This leads to a constant left-to-right shunt between the right and the left ventricle and the right and left atrium. It causes heart failure, pulmonary hypertension and in final stages, Eisenmenger´s reaction (chronic cyanosis).
Junctional Ectopic Tachycardia (short JET): is characterized by rapid heart rate for a person's age that is driven by a focus with abnormal automaticity within or immediately adjacent to the atrioventricular (AV) junction of the cardiac conduction system (AV node– His bundle complex). JET primarily occurs in 2 forms: idiopathic chronic junctional ectopic tachycardia, which is observed in the setting of a structurally normal heart, and transient postoperative junctional ectopic tachycardia occurs following repair of congenital heart disease. In normal individuals, electrical activity in the heart is initiated in the sinoatrial (SA) node (located in the right atrium), propagates to the atrioventricular (AV) node, and then through the bundle of His to the ventricles of the heart. The AV node is limiting the electrical activity that reaches the ventricles of the heart. This function of the AV node is important, because if the signals generated in the atria of the heart were to increase in rate , the AV node will limit the electrical activity that conducts to the ventricles. For instance, if the atria are electrically activated at 300 beats per minute, half those electrical impulses are blocked by the AV node, so that the ventricles are activated at 150 beats per minute (giving a pulse of 150 beats per minute). Another important property of the AV node is that it slows down individual electrical impulses. This is manifest on the ECG as the PR interval, which is about less than 200 milliseconds, the time from activation of the atria (manifest as the P wave) and activation of the ventricles (manifest as the QRS complex). Individuals with JET have a "short-circuit" in their heart, where the electricity bypasses the AV node, causing the heart to beat faster than normal. The cause of the arrhythmia, the ectopic focus, is usually near the AV node in the triangle of Koch (a rough triangle with points at the coronary sinus, the tendon of Todaro, and the tricuspid valve).
Interrupted aortic arch (IAA) is the absence or discontinuation of a portion of the aortic arch.
Thanks for reading...