Chapter 4
As surgeons, we live in a world of worse case scenarios. We cut ourselves off from hoping for the best because too many times the best doesn't happen. But every now and then something extraordinary occurs and suddenly best case scenarios seem possible. And every now and then something amazing happens, and against our better judgment we start to have hope. As doctors, we're trained to give our patients just the facts. But what our patients really want to know is- will the pain ever go away? Will I feel better? Am I cured? What our patients really want to know is- is there hope? But, inevitably, there are times when you find yourself in the worst case scenario. When the patient's body has betrayed them and all the science we have to offer has failed them. When the worst case scenario comes true, and clinging to hope is all we've got left. Meredith Grey, Wishin´ And Hopin´
"Dr. Grey." A voice called behind Meredith. No, not yet. She wasn't ready to face anyone, especially Bailey who had her ways to get what she wanted to know. But she also had no choice. No real choice, at least. Abruptly she turned this around to see who it was. At the same moment she saw Dr. Bailey coming over to her with an expressionless face. "Dr. Bailey." Meredith stammered. "What happened in there, Grey?" She asked. "An explanation would be nice." She eyed her intern suspiciously. Meredith let out a deep sigh. Dr. Bailey looked at her encouragingly. "I do not know." She answered."You do not know. You don´t know?" Dr. Bailey repeated with a sharp, disbelieving voice, the sarcasm clearly indicating that she did not believe the young soon to be- surgeon.
Bailey huffed. Meredith swallowed, her throat felt suddenly very dry. "Of course you do and you just won´t say it. I am Dr. Bailey, I know everything, so I do realize something´s wrong." No, you don't know everything. But that's okay. Okay, it is not. But what should she do without getting fired? Meredith didn´t move, she just waited for Dr. Bailey to continue. "Do you think I approve your unprofessional behavior in my OR, Grey? In my OR you will behave properly. Otherwise I will make sure, you won´t see the inside of an operating room for the next month. Now, do you have a reason why you did leave my OR in the middle of surgery? What was more important than your patient who was being cut open?" Dr. Bailey ranted.
Shit. Damn it. She didn´t plan on telling her that way. Meredith shifted uncomfortbly. "I ... umm ..." Meredith began, she did not know what to respond. Her mind was empty, blank. She honestly had no idea what to tell her superior. Dr. Bailey glanced at her assistant doctor invitingly. "Spit it out, Grey. I'm waiting and I don't have all day." She said sharply to Meredith. Don't you think I know that? I can't tell you, I can't tell anything. If I do I am screwed. Really screwed. I can't. I just ... I can't.
When Meredith did not respond to her question she said, her brown eyes were fixating on Meredith who stared to the ground and seemed to have a great interest in the floor: "What about the cyanosis? Did you at least schedule an appointment with a cardiologist to get it checked out?" She asked. Damn, Bailey's good, she is really persistent. And she cared, otherwise she wouldn't do that. When Meredith shook her head ruefully, she said: "Grey, you are a doctor and when it comes to your health, you are being reckless, so please, do me a favor and go to a cardiologist, Grey. That´s an order." Meredith did not reply. "Grey." She said. Meredith still stared at the floor.
"Grey." She repeated, slight impatience in her voice.
"Listen to me." Finally, Meredith looked up. "You need to see a doctor. A doctor whose specialty are hearts. Cyanosis is a warning sign. You shouldn't take that lightly." appealed Dr. Bailey on the younger doctor's reasonal thinking. She was not about to give up on getting her intern set up with an appointment with a cardiologist. "I know. I should, but I don't think there is anything to worry about." "Grey, don't try and fool me. I know things. Cyanosis is serious, there can be plenty of causes."
"I know." Meredith replied, suddenly standing up for herself.
"Name me some causes. And then tell me why you won't see a doctor." Bailey insisted.
"By abnormal haemoglobin types like Methemoglobinemia, Sulfhemoglobinemia etc. Peripheral Cyanosis. Pseudocyanosis." Meredith answered, intentionally letting out lung problems like COPD and cardiac conditions like heart defects that can also cause cyanosis. Not only peripheral cyanosis, central cyanosis. "That's not all. Come on, Grey. We all know, mostly cyanosis is caused by the circulatory system, meaning heart or lungs."
Meredith looked to the ground. "I know." "You know." Bailey eyed her intern, inquiring her like that didn't make fun at all. She was worried about her. She wanted to help her but this girl's so damn stubborn and won't let her help Meredith. "But if you know what cyanosis, these conditions, can do to you, why the heck won't you go to a doctor?" Bailey wanted to know. "I am new in town, I am in intern. I don't have time to get off work to go to the doctor's. I have night shifts, normal shifts, I am completely booked, not to mention throwing extra shifts in the Emergency Department. I have no time. And I don't need an appointment. I don't need it." She answered, her voice wavered a bit. Bailey noticed it too. Meredith saw the look in her mentor's eyes.
"I'll give you a day off." Dr. Bailey offered, for once her voice was soft, gentle.
"I don't need it. I have work. No time to go to a doctor." Meredith replied, thinking about how she can escape this discussion with her superior. Her superior did not look like she will let her go very easily.
"Grey. You are acting irresponsible. I can do your blood work, send it to the lab and we'll know if it has something to do with hematology. We can also do an arterial blood gas determination and a pulse oxymetry. Nobody has to know." "I don't think that that is neccessary." Meredith said. "I am fine. I am perfectly fine. It is just peripheral cyanosis." She lied right into Bailey's face. "Somehow I don't believe you." Meredith shrugged.
"I am fine. You don't have to." She turned to go.
"Grey. Wait." Bailey called after her, sighing. "Go to a doctor. If you don't, you are banned from surgery for the next two weeks. Are we clear?" Meredith shook her head. "We are not. I am fine, I don't need to go to the doctor." She insisted. "You will go anyway. Before you get yourself checked for any hemoglobin conditions, cardiac conditions and lung conditions you won't set a foot into the OR." She threatened.
"But this isn't fair." Meredith protested.
"You were cyanotic. You have to get yourself checked out. Cyanosis should be taken seriously."
"Cyanosis? Who mentioned cyanosis?" The voice of Chief Webber came from behind Dr. Bailey. Meredith turned around, completely frozen. Her Instincts told her to run, to get away, just... just don´t stay here. But she couldn´t move. Panic was in her eyes, utter panic. Adrenaline flowed through her veins and arteries but she just could not move. She was frozen.
"Dr. Grey, Dr. Bailey. Anybody care to answer?" Dr. Webber ordered with his sonore voice. Dr. Bailey saw the panic in her intern´s eyes and covered for her.
She quickly said: "We were talking about a patient. Nothing is going on, Chief." "Aha." Dr. Webber was not convinced by this explanation. Something was off and he just couldn´t figure out what. They were not talking about a patient. That was clear. He had seen the frightened look on Meredith's face when he appeared. And a look in Bailey's eyes told him that they weren't just speaking about a patient.
"And the patient who is you, Grey? Are you the patient?" He asked suspiciously. Meredith was startled. Dr. Webber had been sitting in the gallery. Had he been sitting in the gallery? She hoped not. Because if he had been there she was in so much trouble. "I have to get the labs. Excuse me." Meredith's voice quivered when she rambled an excuse to get away from here. Dr. Grey escaped. Only when she turned the corner in first gear, she stopped. Breathlessly, she was taking some shallow gasps. That short run had been really hard on her.
Maybe Bailey was right and she should go to a cardiologist. But where? And when?
She had no time, she was an intern. The hospital owns them.
And she can't do an echo on herself, she needed someone else to do it.
Her heart beats shallow in the chest. Breathlessly she gasped for air. For Meredith, it seemed as if she would have make an stronger effort with each breath, to take in enough oxygen, the amount her system needed to function properly. She hoped this feeling would soon disappear ... Meredith's breathing only calmed down slowly. Damn, that was a bad sign, a very bad sign. She looked at the clock, she thought about taking a short break.
She needed that break. She had been here seven hours or eight hours without a break. She did not even thought about thinking. Water. She really needed water. Water was important for her heart. She drew in a deep breath, closed her eyes for a moment and relaxed.
She sighed relieved. She did not admit it, but the twenty four hour shifts demanded yet more from her than she liked to admit. It had been easier when Meredith started her internship. Now, it was hard. Because of her heart but she can't show more weakness than the others. It would make the others think that she couldn't held the pressure. Ellis Grey's daughter, a failure. Who did not get through internship. Damn it.
"Grey, what you are doing here? Go get the lab results like you claimed you would do." Dr. Bailey accused the assistant doctor to a searching look. Tiredly, Meredith nodded and went on her way. Thoughtfully, Dr. Bailey watched her leave. "Damn fools." Dr. Bailey muttered to herself, as she watched Meredith walking away.
"The results of Mr. Martin Sadds for Dr. Bailey. If it were possible, could you hurry up with that?" Meredith Grey leaned against the wall, as the man at the counter with an arrogant tone said: "Everyone needs everything ASAP." "Yeah, sure." replied Meredith. "I need the results right now. As you would say, as soon as possible. So could you just give me the damn labs?" Without returning a word, the man disappeared into a room and returned shortly thereafter with the lab results. "Well, that´s it. Wasn´t that hard, was it?" Meredith said with a wry smile. She rolled her eyes inwardly.
"Umm." The man responded grumbling, his name tag said Mesroe, Jack. Idiot, Meredith thought. What an ass. A complete, dumb ass who has to much free time. Meredith shook her head disapprovingly and was leaving.
Flashback: Meredith, three months
Meredith was now three months old. Now the second and hopefully final surgery would take place. They planned 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. Which meant that there was no way to correct the underlying defect / anomaly of the heart.
The Damus-Kaye-Stansel operation (DKS) with VSD patch closure and conduit implantation between the right ventricle and Pulmonalis trunk is required when there is a high grade subaortic stenosis and under certain circumstances this consuming and difficult operation. The lead pediatric cardiac surgeon anastomoses the Pulmonalis trunk with the aortic root (which is called DKS anastomosis). The former pulmonary valve becomes a neo-aortic valve. Furthermore the surgeon closes the ventricular septal defect with a patch so that the left ventricle drains (former pulmonary valve) in the neo-aortic valve. The lung perfusion is ensured by the implantation of a conduit between the right ventricle and distal Pulmonalis trunk. But since Meredith has no high grade subaortic stenosis, the surgeons tended to the other surgery: Atrial Switch 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´ uses 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´ VSD was sub pulmonic these surgeries weren´t doable anymore.
The Rastelli- operation is the surgical correction of a so-called d-TGA simplex (without other defects): the blood is passed by means of a tunnel-shaped patch from the left ventricle to the aorta, the existing VSD may need to be extended, a conduits takes the blood from the right ventricle to pulmonary artery once the Truncus pulmonalis is closed from the left ventricle.)
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 its own again. 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.
She spent circa five days in the PICU and was then moved to a regular room.
Meredith was searching for Dr. Bailey to bring her the required laboratory results. Dr. Bailey was waiting impatiently. "Where have you been, Grey. I was waiting for you." Dr. Bailey could be really nasty. Meredith muttered softly to herself: "No, just a lecture about ASAP was held." Fortunately, Dr. Bailey had not heard this. "The patient in room 1236 needs a new enema, a patient in room 1570 needs rectal exam and then there is a consult in the emergency department. Sixteen-year old heart patient with unexplained syncope's. Have fun, Grey." Dr. Bailey said, as she was loading Meredith with a stack of medical records. "And I expect complete medical reports of all postoperative patients, including long-term ECG. If it is not there, make one yourself."
"Oh, that´s just great." Annoyed, Meredith looked at the medical records. No break for her. Damn it, she needed that break. Why can't she just make a damn break, just for ten minutes. But now? Now she has to update charts. Probably it is punishment for what happened in the OR. The emergency room was empty for normal conditions. Just two beds were occupied. Bed five, Dr. Bailey said. She took a short glance through the patient´s medical records, before she said half loudly: "Ah, screw it. I am going to do the consult first." She did not intend on letting her patient in the ER waiting for so long, since there might be chance that this girl or boy has a cardiac rhythm disorder or anything else. She looked at the file before she attended to the patient. There was noted that the patient has a history of previous heart problems related to the fact that she was born with a CHD.
Slowly she made her way to her patient. The girl and her mother were waiting patiently.
"Hello, my name is Dr. Grey and I'm the doctor. You are Lily McGee and suffer from unexplained syncope's? Is that right?" The girl looked a bit shy and nodded slightly. "You don´t need be afraid. You are in very good hands. We will make the normal studies as when you go to your cardiologist." Meredith smiled kindly. Lily nodded, she seemed nervous and scared."Okay. Then we will start with the echo and then we are running an ECG. Dr. Burke, our heart surgeon, will come over afterwards and then discusses the results." explained Meredith calmly.
"You have a heart defect?" She asked, looking at the girl, who was sitting on the bed. She looked to the ground and looked like she didn´t want to be here, which was totally understandable, at least for Meredith. She knew what this girl felt. When she was her age, she had a similar expierence, just with a syncope and a sudden awakening in an ambulance on the way to Seattle Presbyterian. "Yes." She said softly. Her mother sighed, looked at her daughter and said: "She has a double outlet right ventricle with Fallot- type." Meredith swallowed, and tried not to let show how much she identified herself with this case. She had been there so many times.
"She is shy." The mother said. "She has always been like that." The girl looked up, her gaze slid to her mother. Anger and frustration were on her face. "Mom, stop it." She hissed. "It's none of her business. We are just here to find out why I keep fainting. Believe me, fainting in front of the whole class is downright embarrassing."
"I can think that it was not a really good expierence. But, no worries, we will find out why. "Have you noticed any other symptoms? Cyanosis, change in heart rhythm etc." After she did a thorough case history, she made sure that she left nothing out, she said: "It's okay. I was like that too." Meredith smiled warmly, reassuringly. She had a good way with patients.
"I'll be right back." She apologized hastily and left hurriedly the ER.
Flashback: Meredith, seven years
"Meredith, come now," cried Ellis Grey. Meredith dawdled again. They had yet to pediatric cardiologist for the follow-up. They scheduled the follow-up in one year Intervals, but anyway, it depends on the results of the echo and ECG when they schedule the next appointment to see if there were any changes in her condition, which, frankly, she did not hope. Meredith seemed normal too, she wasn't easily tired or got dizzy spells or anything. No, she really seemed let's just hope that the exam will not say otherwise.
"I'm coming.", Meredith called back and came after a few minutes stormed down the stairs. "Then we can go." Ellis Grey said relieved, because it was embarrassing to be late to a doctor's appointment. Well, if things get in the way, and it´s not your fault and you can´t do anything about it, if for example a surgery takes longer than planned, that's fine. "Mom, can we eat some ice cream afterwards?" "If you do what the doctor wants you to do and you do it without any discussion, well, then I think about that." Ellis replied and turned her attention to the road. Then they arrived at the practice. Luckily they had not wait for long.
Meredith hates going to the doctor´s, okay, she is seven years old and which seven year old wants to go the doctor? "Hello, Meredith." The doctor greeted Meredith and squatted down in front of her. "Well, then, let take a look at your heart, hm." He laughed and stood up again and shaked Hands with Ellis: "Dr. Grey Nice to see you." After a brief conversation of it went over to the room on whose door stood echocardiography. "Well, Meredith, then make your upper body free and lie down for me." He told little Meredith.
While Meredith made her upper Body free, the doctor left the room. When Meredith was ready, he entered the room. "Attention." He warned Meredith, whose eyes where fixated on the Monitor showing films about the ocean. The light in the echo room was slightly dimmed so that the physician could see the image on the monitor more sharper and better. "It's getting cold now." He began with the four-chamber view, then wandered over to the two - then three-chamber view.
Ellis looked at the screen to make sure, nothing would be missed. Then the apical five-chamber view. Next, the pediatric cardiologist echoed the heart valves, first the aortic valve, then the pulmonary valve and then the mitral valve and at least the tricuspid valve. After he had the heart looked at the various scan views and in M-mode, he ended the sound satisfied. It was all okay, without any big pathological abnormalities besides a little hole between left and right heart with a small left-to-right shunt. It was a residual defect. Maybe it would close itself within time.
"Now only the short-term ECG and then the 24h ECG." "Oh no." Meredith protested, horrified. She hated that. These dots terrible on the skin when removed. "But, Mer, you have to do it, the doctor needs to see if your heart is beating properly." Ellis told her struggling daughter and tried to calm her. Finally it worked. Meredith lied down and the pediatric cardiologist was able to record her heartbeat. Ellis was looking over the doctor´s shoulder, making sure that the pediatric cardiologist nothing missed on the electrocardiogram.
After two to three minutes they were finished. "So, we are finished here." The physician said and began to disconnect the ECG leads. Then there were the electrodes left. "No. No. No. I don´t want that." Meredith protested, she knew what came after disconnecting the leads. These electrodes were evil. They "hurt" the skin whenever you pull them off. "Meredith, pull the ECG points slowly off and Put pressure externally with your finger against the ECG point, that it does not twinge as much as it does now." The man in the White coat advised, when he saw the girl struggle with pulling off the electrodes.
When Meredith was fully clothed, equipped with Holter-ECG that is supposed to record her rhythm for twenty-four hours, he wanted to make an appointment for the next for the next cardiac catheterization. "The last heart catheter exploration we did was four years ago. I´d like to do one every three years, so that means we have schedule one in the near future."
Ellis nodded. She understood that. When she was finished scheduling a appointment for catherization, she and her little girl left the doctors practice. "Mummy, what about my ice cream." Meredith protested when Ellis was walking towards her car. "Psst, Mer, I will get your ice cream. But first, I need to get some files from the hospital." "But Mummy, you promised I will get ice cream after we went to the doctor." "You will get it. Just try and be patient." "I am done being patient. I don't like the doctors appointsments. The thingies on my chest are hurting. I don't like it. And you, you promised me an ice cream." Between Meredith's whiny behavior, Ellis pulled to the side and stopped the car next to an local ice cream parlor.
"See." She said. "I told you will get your ice cream." "Thank you, Mommy. I love you. Come." Neredith was happy when she learned that she was going to get her ice cream. "I will chocolate and strawberry." Meredith exclaimed, jumping up and down. "Meredith, just one scoop of ice cream, okay? If you eat to much, your belly will start hurting." Meredith decided she wanted strawberry ice cream. When Ellis had paid for it, both of them made a short back to the near ocean and looked at the water. Today was windy and a bit cold. "Look, there is a boat."
"It's a ferryboat. There are people on it that want to the other side of the city."
With big eyes, Meredith watched the sailboats and ferryboats with the passengers. "It's great here. We need to come more often." Meredith suddenly said, her gaze slid over the blue water. Ellis smiled, this was a good day. Her daughter was happy despite the appointment to the doctors office. "Yeah, you are right." She said, thinking about her and Richard being here and looking out of the water. Meredith's voice brought her back to reality.
"Mummy, look. A small stone. Can I throw it in the water." She wanted to know. In her hand was a little, small stone. Too small to do any kind of damage with it."Yeah, but don't go to close to the rim. The water is very deep and it's ice cold. If you fall, you'll drown and / or get hypothermic. And I don't intend on letting this happen. So, at least one metre between you and the water." Ellis warned and looked attentively at Meredith. "Okay." Meredith throwed the stone into the water and watched it disappear.
Dr. Bailey was worried. She was really worried about one of her interns. Of course these five don't know how to stay out of trouble. The incident with Meredith in the OR where she turned cyanotic replayed in her head over and over again. This wasn´t normal. Healthy People don´t turn blue for no reason. She was pretty sure that there was something going on, so she decided to talk to the chief. When she finished her surgery, she went to the chief´s office, hoping he was there and not in surgery. She thought about what she should say.
When she walked towards his Office Patricia, his secretary stopped her. "He has a lot to do. A lot bureaucratic things, mails to answer and Budgets to look over ... Short, he doesn´t want any interruptions or staff burging in wanting something from him." "Well, I am not like other staff. I am his favourite resident and I want to speak to him right now. It does concern one of the interns, my interns." Patricia shook her head. "Sorry, but now interruptions." Dr. Miranda Bailey just scoffed and knocked on the door to the chief´s office.
Then she opened it. "Bailey. What are doing here. I told Patricia no interruptions." Dr. Webber told her, obviously surprised that she had disregarded his instructions. He looked up from his paperwork. "Yes, you did. But I ignored it." Bailey said. "Look, this does ..." Dr. Webber told his resident. "it is about Meredith Grey, who is ..." "... like the daughter I never had, yes. Go on."
He leaned back, sighing.
Dr. Bailey nodded and started speaking: "I worry about her, Chief. She turned cyanotic in my OR, but won´t tell me anything."
"Cyanosis? So you weren´t talking about a patient?"
"No, Sir." Dr. Bailey replied, she looked to the ground.
"Thank you for telling me. I will do something about it and find out what is going on- even if it involves speaking to Cristina Yang, maybe she knows something that could be helpful." Dr. Webber told her.
"What am I going to do?" Dr. Bailey asked. "Well, should I confront her another time or just act like nothing happened?" "You know the answer to that, Miranda." The chief just replied. "I do. Thanks for taking time for me and my matter of concern." Dr. Bailey said. "I´ll have another surgery in half an hour. I really should get going." She then leaves the office.
Dr. Richard Webber stared after her, unable to concentrate on mails he us supposed to answer.
He really should find out what is going on with Dr. Grey ... after all, she is Ellis's little girl and nearest thing he has to a daughter. And she may need medical attention.
She met Derek, who also worked in the meantime. "Hey, Meredith. You okay?" He asked and greeted her with a long kiss. "You look tired." He said after a quick glance. "I have a consult in the pit, oh, and I´m running labs." She pulled away from Derek. "I'm sorry, but I gotta go. I need to find Dr. Burke." Meredith concluded. "Okay. Good luck." Derek told her and pressed her still quick kiss on the forehead before Meredith went to find Burke. Meredith gave him a grin and Derek watched her leave. Finally she found Dr. Burke at the nurses' station.
"Dr. Burke. I've got a case." Meredith said slowly. Dr. Burke held a coffee cup in his hands and looked at her questioningly. "Sixteen-year old girl with cardiac history with unexplained syncope's." "Okay. What about her medical history?" He wanted to know more about that. "She was born with a double outlet right ventricle with Fallot- type." She told him and waited for his answer.
"Okay, this is what you gonna do: run an ECG, pulse oximetry and echocardiography." He ordered. "Page me when you have the results." "Okay, then." She agreed quickly. Meredith took the patient and the mother to the room where the ultrasound machine was. Friendly smile, she invited them in and said: "We´re going to perform an echocardiography and then an ECG, I'll be back in about two minutes," Meredith gave Lily an encouraging smile and left the exam room.
After two minutes she entered the exam room again and reached for the transducer. "Okay, it is gonna be a little cold." Meredith warned the cardiac patient. Then she started with the ultrasound. First the Apical four-chamber view. She placed the transducer on the fifth intercostal space, approx. left midclavicular. The left (LV) and the right ventricle (RV), as well as the left (LA) and the right atrium (RA) can be displayed on the screen, then she turned the transducer aproximately 60° counterclockwise from the previous position. Now she could see left atrium and the left ventricle.
Lily kept staring at the ceiling. The mother stared nervously at the monitor on which a beating heart could be seen. Meredith was fascinated.
Even if she knew what it was like when the heart is malformed or does not beat properly, it's a small miracle. Cardiac surgery was interesting, even if she doesn´t want to be a heart surgeon- now that was rather Cristina, who was crazy about the heart. The Girl was nervous. She knew how she felt. She knew this feeling all too well. Each time when she had gone to the follow-up she experienced this fear, the doctor might discover something and that requires re-surgery. Every time Meredith was glad when it was over again. She hated to be the patient. After Meredith had finished the echocardiography at Lily, the glue dots was stuck on her chest, which was for the unipolar precordial leads (by Wilson) absolutely necessary.
When the glue dots were systematically attached to the left and right parasternal line, one on the midclavicular line and two on the axillary line in the intercostal, Meredith started the recording of the heartbeat. "So, let's get started. Please do not move for three minutes.", told Dr. Grey. There was a special program in the Computer for this. Then they did an stress ECG, which was taken on the Ergometer. After two minutes Meredith noticed Lily struggling for air and instantly looked at her sats.
Her oxygen saturation went down to 95%, which was borderline. So Meredith stopped the stress ECG, and said: "Lily, I say that you may not be able to do sport in the near future, unfortunately." "Why?" Lily asked a little out of breath. "Because your oxygen saturation fell. After three minutes it was only 95%." Meredith continued, trying to make eye contact with the girl. "Can I go home?" Meredith shook her head. "No, you gonna be admitted for further studies, until we know what´s going on. I'm sorry." Meredith said once the pulse oximetry was finished.
After the girl was admitted, they moved her to a patient room. After a while the mother went to get a cup of coffee, Meredith entered the room. Lily was reading and looked up as soon as she noticed Dr. Grey standing there. "Hey, I just wanted to see how you are feeling." Meredith began. Lily let out a deep sigh. "I hate being in the Hospital.", she finally admitted. "Don´t take it personally, but you have no idea what it´s like to live like this."
"Well." Meredith said. "Actually, I do." Lily looked at her in surprise. "Really? You do?" She asked, unsure how to respond. Meredith nodded and sat down next to Lily´s Hospital bed. "Okay, I am going to tell you something. And could you... maybe... Don´t tell anybody. Or mention it when Dr. Burke talks to you about your test results. Because nobody knows and I don´t want anybody to know."
Lily nodded, and waited for her to continue: "I was born with the same condition as you. I´ve had three surgeries. One when I was a few day old, the next after a few months. And when I was five, they discovered that I had a right outflow tract obstruction. They repaired it in surgery."
"I had only one surgery. Why did you have had surgery so many times, I mean, beside the one at the age of five." Lily asked.
"And how did your classmates react, when they found out about your heart defect? Or is that question too personal?" "No, you can ask. You know it wasn´t just an "double outlet right ventricle", I also had an AV Canal Defect and an interrupted aortic arch and Aorta was hypoplastic, which was corrected in the first surgery. Then they did an atrial Switch Operation and corrected in the same session my other heart defect-"
"Interrupted? How is this possible?" Lily was shocked. How could you live with an interrupted aorta? That is impossible. "IAA is often combined with DORV. It´s called a Taussig- Bing- Anomaly. In order to survive, they tried to keep my patent ductus arteriosus open to allow blood flow. A PDA is a fetal Connection between the aorta and pulmonary artery." Lily understood.
"Did your former classmates..." Meredith looked at her patient.
"...know about my heart condition? Yes, they did know. But for them I was nothing. They thought I had some weird kind of special rights, because I often left school because of doctor´s appointments. And then, one day... There was the Thing with me having arrhythmias. I passed out during PE. They had to call an ambulance. But they didn´t understand or neither wanted to. For me it was okay. I dealt with it, but remember being relieved when I graduated high School." Meredith told her patient, who was just listening without interruptions.
"But I had one good friend. Her name was Sadie. She was always there for me. After school we both traveled to Europe and had an big argument. We never talked again. It destroyed our friendship. I went to med School and graduated. Now I am here. I survived. I am going to be a surgeon one day. And I know you will survive too. High School is cruel sometimes, I´ve been there. Just don´t give up. It´ll get better. Keep that in mind, okay?" Meredith finished her monologue.
Lily just listened. But before she had the chance to say something, her mother entered the room. "Dr. Grey. What a pleasure. Is everything okay? Do you have test results?" She asked, placed her coffee cup on the table near Lily´s bed and glanced at her questioningly.
Meredith quickly stood up and explained: "I was just taking her vitals and we somehow ended up talking." "Oh, she talked? She doesn´t do that a lot. I am beginning to think it may be because of her, you know, condition and because of school. She always had been very quiet." Meredith was thankful that Lily interrupted her mother. "Oh, mom, please. Stop it." Lily hissed. "Okay, okay. I´ll stop." "I have to go. Work. I will come back and check on you, Lily. Bye, Mrs McGee." Meredith left the hospital room to give them some privacy.
A/N: Rastelli- procedure: The principle of the Rastelli operation at a d-TGA with VSD and pulmonary stenosis based on the fact that the left ventricle must supply a high pressure through a constriction in the lower part of the pulmonary artery and therefore the light coming from the lungs of oxygen-rich blood through the VSD in the aorta can flow. The circulations are separated at the level of the ventricles by inserting a valved conduits and thus the functional closure of the VSD. The conduit must be replaced later depending on age and time of surgery. Because after this surgery the left ventricle pumps oxygenated blood to the systemic circulation and the right ventricle pumps venous blood to the pulmonary circulation, it is also an anatomical correction. Then I have mentioned a procedure named REV procedure, it is short for Réparation à l'Etage Ventriculaire.
About the exam room Scene with Meredith and her mother, I didn´t made up the TV with the film about oceans. I don´t know how other doctors distract the children when they get an echo, but my cardiologist does it like that, I mean with the film. Now I always peek towards the monitor to get a chance to see my heart, cause it´s amazing and intense. It is nothing you experience every day. How often do you schedule such an appointment? That depends on heart defect and the severity of it and possible residual defects or any kinds of abnormal heart rhythm. YOur cardiologist will tell you when he / she wants to do the next echo.
Also, I just had to write the ´Lily and Meredith´- scene in the end. Meredith´ Chance to give advice to a young girl who is in the almost same position as she was when she was in high School. See, that is me rambling. I hope you liked it and hopefully leave a review...