Thank you everyone for your wonderful comments!

I groan when I hear my pager start beeping on the nightstand by Derek's side of the bed. I pry my eyes open and roll slightly on top of him. I lay my cheek on his chest as I pick my pager up and turn it off. "Crap," I mumble as I toss it back down on the nightstand and bury my face in Derek's t-shirt.

Derek runs his hands up my back as I lay on top of him. "Morning," he says quietly without opening his eyes to look at me.

I scoot my body higher on top of his and kiss him softly. "It's not morning. It's two a.m.," I grumble before rolling back off of him. His hand stays on my back as I force myself to sit up. He turns his body over to look at me as I grab the phone and dial the hospital. I rub my free hand across my eyes to help myself wake up. "This is Dr. Shepherd," I say into the phone. My eyes close again as I pull my knees to my chest and listen in the dark to the nurse. "Go ahead and book an OR for four o'clock. I'll be there in an hour to meet with her parents," I say firmly. I hang the phone up and toss it onto my nightstand. I press my face into my hands and sigh sadly.

Derek wraps his arm around my waist and lays his face onto my stomach as I extend my legs and sit with my back against the headboard. I smile down at him and run my fingers through his hair. "I have to go. It's Alyssa," I say quietly. Derek lifts his head and looks at me with concern. I can feel his eyes on me as I stand up and walk into the bathroom to take a quick shower.

I quietly open the door to Emma's room and walk over to her crib. My fingers run softly through her dark curls while I watch her sleep. A smile crosses my face when Emma lets out a tiny giggle, and I try to keep myself from laughing at how adorable she looks when she is dreaming. I pull her pink blanket back up over her chest before leaving her room and walking to Jacob's. I open his door and kneel down by his bed. Panda lifts his sleepy head off of Jacob's arm and looks at me. I scratch him gently on his furry neck before pulling Jacob's blanket back over his body. I notice something bulging out of the bottom of the covers, so I pull them up slightly and look underneath. I smile wide when I notice Jacob has slept in his rain boots and favorite pair of 'fishing' pants. I tuck the blanket back around Jacob's legs and kiss him softly on the cheek before I leave his bedroom.

"Here's your breakfast," Derek says with a smirk as he hands me a travel mug full of coffee. He leans his body back against the wall by the front door and runs his hand through his messy hair. He smiles at me softly as I take the cup from him.

"Thanks," I say as I reach up and wrap my free hand around his neck. I pull his face to mine and kiss him firmly. "Have fun with the kids today. Hopefully I can make it home before dinner," I tell him.

He runs his hands across my waist and tangles them around my back. He pulls my body tight against his and buries his face in my neck. "Are you alright?" he asks against my skin before placing a warm kiss on my collarbone.

I sigh as I close my eyes briefly and say, "This will be the second time I've operated on her in three months. I have a bad feeling."

Derek lifts his head and smiles slightly at me. "You know you can't think like that, Meredith. She needs you to be confident when you step into that OR," he whispers as his hand caresses my cheek. I close my eyes and enjoy the warm comfort of his hand against my skin.

I force a small smile on my face and say softly, "I need to go to work. And you need to go back to bed. Maybe you can get a few more hours of sleep before Jake decides it's time to go fishing."

Derek groans and mumbles, "I did tell him we would fish this morning, didn't I?"

I smile and say, "You did. And he slept in his rain boots, so he's going to be ready to go as soon as his eyes open." I lean forward and kiss him again quickly.

Derek holds me tight and brings his lips to mine once more and says, "I love you."

"I love you, too, Derek," I whisper before pulling out of his embrace and opening the front door.

I walk into the waiting area and spot Alyssa's parents. They immediately stand up to come greet me warmly. I can see the concern on their faces, so I try to look confident and reassuring. "Mr. and Mrs. Morgan, good morning," I say as I extend my hand to shake theirs.

"Dr. Shepherd, why are we pushing the surgery up so quickly?" Mr. Morgan asks me. His face looks tired and worn as he looks at me with fear in his eyes.

"Alyssa's breathing became more labored over night. I feel it's best if we go ahead with the surgery as soon as possible. We can't wait until Monday as we had planned," I say as I nod my head.

"But it's only been three months since her ASD procedure," Mrs. Morgan says. "Isn't she still recovering from that? Isn't this too soon? What about a transplant?" I can see tears forming in her eyes and I swallow a lump of nervousness in my throat.

"It is soon, you're right. But Alyssa is a fighter. She's very resilient, and I wouldn't do this procedure this morning if I felt she wasn't ready. She is on the transplant list, but she's not at the top. We can't wait, Mrs. Morgan. Her heart is starting to fail. The Ross procedure is an extensive surgery, but once it's completed, Alyssa shouldn't need another surgery for a very long time," I say. I reach my hand out and place it on her arm to comfort her. "There are risks, though, especially with her heart being weak. We've gone over those already, right?" I look back and forth between their faces, and they both nod silently to me. I give a reassuring smile and say, "Alyssa will be taken down to the OR in ten minutes. You have time to see her before they take her out of her room. I'll send someone out to keep you updated through the surgery." I turn and walk out of the waiting area and head to the locker room to get changed into my scrubs.

I look at the tiny, sleeping, angelic face in front of me and then at her chest. I look at the scar from the last time I cut her chest open and take a deep breath. I extend my hand to the scrub nurse and ask for a ten blade. My hand is steady as I cut Alyssa's chest again. After her chest is cracked and open, I smile under my scrub mask when I see that the hole in her heart that I repaired only three months ago is completely healed. "You are a fighter, Alyssa," I say quietly. Suddenly, I feel confident that this surgery will have a good outcome.

Hours pass as I remove and replace valves with a steady urgency. As I close the last stitch in her heart and prepare to take Alyssa off of the bypass machine, the image of her parents suddenly fills my consciousness. I shake my head to get the image out, and I tell the technician to shut off the bypass machine. I hold my breath as I wait for Alyssa's heart to begin beating on its own again. My heart begins to race as adrenaline surges through my body when I realize something is wrong. The tiny heart isn't working. I flick it with my finger to encourage it to beat. I wait silently in anticipation. Too much time is passing and I yell at my intern to hand me the paddles. I mutter, "Damn it, Alyssa," as I send a current of electricity to her still non-beating heart. I shock it again when there is no response. My stomach aches as I shock her tiny heart for a final time and realize that it's not going to beat ever again.

I drop the paddles onto Alyssa's stomach and let out a long angry breath. "Time of death, fourteen twenty-three," I whisper before turning to hurry out of the OR. I methodically pull my gloves and mask off and toss them in the trash. I angrily turn on the water and scrub my hands under the scalding water. I can feel tears forming in my eyes and I feverishly blink to keep them from spilling over. "Keep it together," I tell myself as I prepare to deliver the worst news of their lives to Alyssa's parents.

I try to keep my emotions in check as I approach her parents in the waiting area. They see me and stand, only to drop back into their seats when I take an unsteady breath and begin to speak. "I'm so sorry. The surgery went smoothly, but her heart just wouldn't start beating again. Alyssa's heart was just too weak to start beating on it's own," I say as I shake my head. I know that her parents no longer hear me as they sit in anguish holding onto each other like life preservers. I close my eyes momentarily and take in a deep breath. "Social services will be down to speak to you shortly," I say softly as I wring my hands together. I turn and walk quickly out of the waiting area and run down the hall to the residents' lounge. I enter the restroom and sit down on the floor with my back against the wall. I bring my knees to my chest and I press my face into them.

Angry silent tears fall down my cheeks while I go over every step of the operation in my head. I lose track of how long I sit there, and finally the door opens. I wipe the tears from my face and look up to see Izzie standing there looking down on me with understanding. She slides her back down the wall and sits next to me silently. I rest my forehead in my hand as I look down at my knees.

"I hate my job," I say quietly as I turn and look at Izzie.

Izzie smiles at me and shakes her head. "No you don't, Meredith. You love it. You hate that you can't save everybody," she replies. She nudges my shoulder with hers and looks down at her hands as she sits cross-legged next to me.

"Fine," I mutter sadly. "I don't hate my job. I just hate that a four-year old died on my table this morning." I look at Izzie and give her a small smile.

"There's always room for you on my surgical team if you want to make the switch," Izzie teases as she smiles widely at me.

I roll my eyes playfully and say, "Join the gynie squad? No thanks, Iz." I smile at her as she stands up and extends her hands down to me. I grab her hands with mine and she pulls me off the floor.

"You ok?" she asks as we stand facing each other.

"Yeah," I lie.

I pull my car into the driveway as the sun is setting behind me, and I can see Jacob standing on the couch staring out the living room window. I smile to myself when he begins waving happily at me. I get out of the car and am immediately greeted by Jacob when he wraps his arms tightly around my legs.

"Hi, Mommy!" he says cheerfully as he looks up at me with his big blue eyes.

I giggle and say, "Hi, Jacob." I stick my hands under his armpits and lift him up against my body and hug him tight.

He wraps his legs around my waist, and my neck is strangled by his arms as he returns my hug.

"Not so tight, Jake," I say softly as I try to pry his little hands from around my neck.

Jacob pulls his face back and says, "Sorry, Mommy." He kisses me quick on the lips before wiggling out of my grasp and jumping to the ground. He runs across the yard and up the steps to the house. I follow him slowly to the house, and shut the door behind me as I go in.

I smile widely when I see Derek sprawled out on his stomach on the floor. He smiles back at me as Emma sits on his back with her little legs straddling his waist. Emma looks at me and begins bouncing up and down excitedly while Derek groans underneath her. I giggle as I sit cross-legged on the floor next to Derek, and Emma grabs a big handful of his hair and pulls.

Derek groans again and says pathetically, "I hate being the horsie." I can't help but laugh as Emma continues to bounce up and down on his back.

"You love it and you know it, Derek," I tease as I bend forward and kiss Emma quickly on the forehead. "Hey baby girl," I say through my smile. Emma reaches her hands out to me, and I lift her off of Derek's back. I lay down on my back and let Emma straddle my waist. She leans forward and lays her head down on my chest as she sticks her thumb in her mouth, and I wrap my arms around her back.

Derek turns on his side and props his head up with his elbow. "Ok, that's just not fair," he whines with a smile. "She breaks my back all afternoon with her tushy, and you walk in the door and get all the snuggles." He scoots his body close to mine and kisses me softly on the lips. He can tell when he looks in my eyes that I've been crying.

I smile softly at him before turning my face to look up at the ceiling. I sigh sadly and run my hands through Emma's hair as she cuddles further into my chest.

Derek presses his lips against my ear and wraps his hand across my stomach. "I love you, Sweetheart," he whispers into my ear. I turn my face to his and give him a small reassuring smile. He places a soft lingering kiss onto my lips, and I feel a tear escape from my eye and roll down my cheek toward the floor.

Derek wipes the tear from my cheek with his thumb as he says quietly, "You missed dinner."

I swallow guiltily and say, "I know. I just needed some time to pull myself together before I came home."

Derek nods in understanding, and he kisses my cheek as I look back up at the ceiling. I close my eyes as he kisses my neck, and he puts his hands on top of mine as I hold Emma tight against my chest.

"She's ready for bed," Derek says softly against my ear as he nuzzles his face against my cheek.

I smile and nod as we both sit up. Derek stands up and takes Emma from my chest, and extends his free hand to help me stand. Emma holds her hands out to me, and I take her from Derek. "Come on, Em. Let's get your jammies," I say as I walk up the stairs with her.

Jacob runs past me as he hurries down the stairs, with Panda right behind his heels. "Hi, Mommy! Bye, Mommy!" he shouts loudly as he jumps over the bottom step and races for the kitchen.

"Hmmm…he must be after ice cream," I mutter softly to Emma. I put her down on the carpet as we walk into her bedroom. She takes a few unsteady steps toward her toy box, and then drops to her knees and quickly crawls the remainder of the way. She reaches in and grabs a stuffed puppy out of the box, and plops down on her bottom with it as she hugs it against her chest. "Paa," she says as she looks up at me and smiles. I smile back down at her and say, "Yeah, Panda." I grab a pair of green polka-dotted pajamas from her drawer and a clean diaper from her changing table. I walk over to Emma and sit down next to her on the floor. I pick her up and then lay her down between my legs and begin undressing her. She fusses as I tear off her old diaper and shove the new one under her body.

"Stop wiggling, Em," I say softly as I try to stick her feet into her pajamas. Emma rolls over and starts crawling away quickly with one foot still in her pajamas. I lunge forward onto my stomach and grab her around the leg to make her stop crawling. "Get back here, you little monkey," I say as I sit up on my knees and pick her up.

I lay her back down and shove her feet into her pajamas before she can roll over again. I run one finger up her belly and leave a tickle trail up to her nose. She giggles at me as I stick her arms in her jammies and zip up the front. I stand her up in front of me and smile as she reaches forward and touches my nose with her hand. I pull her body close to me and hug her tight before kissing her repeatedly on her cheek. I stand up with Emma against my chest, and I walk over to the rocking chair. "Want to rock with Mommy?" I ask as I sit down and wrap her blanket around her back. Emma looks up at me and shoves her thumb into her mouth as she lays her head on my shoulder. We rock silently for a few minutes, and then Emma begins to squirm. I stand up and say, "Alright, Em. You can lay down now." I lay her in her crib and tuck her blanket around her chest. My fingers run through her hair as I watch her roll onto her side and close her eyes. I stand quietly and watch her as she drifts off to sleep. I reach onto the floor and grab the stuffed puppy she was playing with and place it next to her in the crib. My eyes fill with water as I watch my perfect healthy daughter sleep peacefully below me.

"I hope you boys saved me some," I tease as I walk into the kitchen and sit next to Jacob at the table.

Jacob laughs and says, "Sorry, Mommy. You have to eat your dinner first." He points his finger towards the microwave. "Daddy made broccoli and cheese. He just heated it up for you."

I scrunch my nose up and say, "You're kidding, right Jake? You're going to make me eat broccoli while you chow down on strawberry ice cream?"

Jacob shrugs his shoulders and says, "I don't make the rules, Mommy. Eat your dinner like a good girl, and then you can have ice cream." He smiles at me and shoves a large frozen strawberry in his mouth.

I laugh as his face contorts into a scowl and he spits the strawberry back into his bowl. He wags his hand in front of his mouth and says breathlessly, "Too cold."

I wink at Derek as I stand up and walk over to the microwave and take my dinner out. I grab a fork and plop the plate onto the table and sit down. "Mmmm," I say sarcastically. "This is way better than ice cream." I take a big bite of broccoli and wiggle my eyebrows at Jacob. "Wanna trade?" I ask him.

Jacob folds his arms over his ice cream and says, "No way, Mommy. You're not tricking me like that again."

Derek and I laugh as we watch him eat his ice cream with his face two inches from the bowl to keep me from sticking my fork in it.

"So, did you and Daddy have fun fishing today, Jake?" I ask as stand up and put his Clifford book back on the bookshelf next to his bed.

He smiles at me as he pulls his blanket under his chin. "Yep. I caught a huge fish, Mommy. But Daddy didn't get to fish. He just kept wiping mud off of Emma's hands cuz she kept eating it. She was sooooo messy." He rolls his eyes and shakes his head.

I giggle as I sit down on the bed next to Jacob. I run my hand across his forehead and push his hair off his face. "I love you, Jacob," I say softly before bending down and kissing him on the cheek. He wraps his arms around my neck and hugs me tightly. I lay my face against his shoulder and close my eyes while he squeezes my head.

"I love you, Mommy," he says as he finally lets me go. "Sorry I didn't share my ice cream." He smiles innocently at me as he rolls over onto his side.

I smile back at him and say, "That's ok, Jake. I had to eat my dinner first anyway." I look down at the floor and snap my fingers at Panda. He lifts his head off of the carpet and runs over to me. I pick him up and put him on the bed next to Jacob. "Goodnight, boys," I say as I stand up and walk to the door. I look back at Jacob before turning off the light, and smile when I see him with his arm wrapped tightly around Panda's back.

I walk into my bedroom and grab a t-shirt out of the dresser. I quickly take my blouse and pants off and unhook my bra, throwing my clothes carelessly to the floor. I pull the t-shirt over my head and walk over to the bed. I sigh and flop down onto my back and close my eyes. I hear Derek walk in and shut the door.

He sits down on the bed next to me and says, "I brought you something."

I smile and open my eyes, and giggle when I see him holding a bowl of strawberry ice cream in front of me. I sit up and lean over to kiss him. "Thanks," I say as I take the bowl from him. I scoot my body up the bed and sit with my back against the headboard. Derek walks to his side of the bed and sits next to me. I can feel him looking at me, and I say, "I don't want to talk about it." I take a big bite of ice cream and stare into the bowl.

Derek turns his body to face mine, and he runs his hand along my stomach. "Ok," he says softly. He nuzzles his face into my arm and sits quietly next to me as I eat a few more bites. His hand moves off of my stomach and down to my bare legs. I can feel goosebumps forming where his hands have roamed. I smile as he scoots lower on the bed and rests his head onto my stomach. I reach over and put the bowl onto my nightstand, and then run my fingers through his hair as he continues to rub my legs and thighs with his hands. He buries his face into my stomach and kisses me through my t-shirt. I let out a soft breath and close my eyes. "She had the same birthday as Jake. They were the same age," I say quietly.

Derek lifts his head and looks sadly at me. "You did everything you could for her, Meredith. You know that," he says softly as his chin rests on my stomach.

I nod my head and run my nails gently against his scalp. Derek closes his eyes and kisses my stomach again. I force back tears that are forming in my eyes as Derek scoots his body back up even with mine. He places his hands on both sides of my face and makes me look at him.

"I love you," he whispers before kissing me softly on the lips. I smile slightly at him as he pulls away. He releases my face and climbs on top of me.

I wrap my legs around the back of his, and my hands tangle around his neck. I stare into his eyes for a moment, and then I say, "I want another baby."

Derek frowns and takes a quick breath in before saying, "What?"

I smile and say, "You heard me." I play with the curls on his neck as he stares at me.

He places a kiss onto my collarbone before climbing off of me. His body melts into mine as he scoots next to me and wraps his arm around my waist. "What brought this on?" he asks as he studies my face.

I shrug my shoulders and say, "I don't know. I"ve been thinking about it for awhile. I just…" I sigh and shake my head.

Derek nuzzles his face against my shoulder and says, "You just what?" He looks into my eyes and his fingers play with the hem of my t-shirt at my waist.

"I just want Jake and Em to have what I didn't," I say as I turn sideways to face my body to Derek's.

His arm wraps tightly around me, and he pulls me close to him. I wrap my arms around his shoulders and pull him on top of me as I turn over on my back. "They already do have what you didn't, Meredith," he says softly. I smile at him as he positions himself on top of me, and I wrap my legs around him again.

"I want them to have more," I say. I smile as a huge grin breaks across his face.

"You're sure?" he asks. His eyes begin to twinkle as he looks down at me.

I nod my head and smile. I run my finger along his jaw bone, and he turns his face to kiss my hand. "Yeah, I am. What do you think?" I ask.

He leans his face down to me and kisses me softly. "I want you to be happy, Meredith. That's all I've wanted since the day we got married.," he says as tears start to form in his eyes.

I sigh and say, "You said two was all you could handle." I wrap my legs tighter around his.

"I lied," he says with a small laugh. I giggle and say, "I knew it."

My smile fades as Derek takes my hand in his and entwines our fingers together. He leans forward and kisses me softly. His tongue brushes against my bottom lip, and I open my mouth for him. The kiss slowly grows into something passionate and fierce as Derek's hand raises my t-shirt up and he rubs my breast with his thumb. I raise my arms above my head and allow him to take my shirt off. He does the same to his, and then reclaims his spot on top of me. My breathing becomes ragged as Derek's hands begin to roam down my breasts and stomach while his lips assault my neck and chest. "God, I love you," I say breathlessly as Derek lifts his head to kiss my lips.

He smiles at me and says, "I love you, too."

HAPPY GREY'S DAY TOMORROW!