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The Fight For Four
Chapter Ten
The next twenty-four hours were hell for Derek Shepherd. He fought hard to stay awake when he could, to communicate with Meredith when he had the strength and the cognitive ability to write a couple of words, but frustration and pain plagued him. Despite his conscious state, his respiratory effort hadn't really improved those first twelve hours. He'd tried so hard to get his lungs to work and his mind to connect the dots and send the message that he needed to breathe on his own, but it was so much harder than it sounded. Just the effort it took to try to breathe took enough out of him that he stayed awake only in ten minute intervals. Usually it was just long enough to see his wife's face, exchange a small communication, realize how much pain he was in, then go back to sleep again.
Despite everything, Meredith stayed at his side. She was there every minute, grateful that she'd slept at home before he'd opened his eyes. Mark and Carolyn had come by to see him for an hour or so, but he hadn't really been up to visitors so they hadn't stayed long. Carolyn had snuck Weston in, which Meredith was grateful for. Even if he couldn't do more than just touch him, she was happy Derek had been able to see his son. For the most part, despite still being in the ICU, it was just the two of them. She didn't really mind that, though she wished he was able to talk to her.
"Good morning," Teddy walked into the room twenty-four hours after they'd discontinued his sedation, taking a few minutes to do a thorough examination before she sat down to talk to them. "Believe it or not, Derek, you're doing really well. I'm really pleased with how much progress you've made in the last few days." She could see the disbelief in his eyes, and she immediately felt sympathetic, wishing there was something more she could do for him. "How's your pain right now?"
Meredith looked over, answering for him, but only because they'd discussed it not long before. Somewhere along the way they had devised a system. One squeeze to her hand for yes. Two for no. So she knew he was hurting. "Still pretty bad, as of an hour ago."
Teddy nodded, glancing at his monitors. "I'll see if we can adjust some things and get you some more relief." She paused. "You did really well overnight with breathing, and I spoke to the respiratory therapist about seeing if we can take you off the ventilator this morning. I think it's worth a shot."
Meredith could see Derek's apprehension, though she knew he desperately wanted it gone. She couldn't help but wonder if he was scared it would fail, or scared of the actual procedure to remove it. It was too complex of a question to ask though, in the middle of their conversation with Teddy. She reached over and took his hand, giving it a gentle squeeze. "What about his chest tubes?" She knew from experience those things hurt like hell.
Teddy nodded. "We can probably take those out too. I don't want to do much else right now though. Lets try this and see how it goes before we change other things." She looked over at Meredith. "I'm assuming you want to be here?"
"Yes." Meredith answered quickly, smiling a bit when Derek squeezed her hand. It felt good to know that he wanted her there too.
"In that case, let me page Patty and we'll get to work."
The respiratory therapist showed up a few minutes later, taking a few minutes to get everything set up before they started. "Tube's coming out on three, Dr. Shepherd. Just try to relax. This may be a bit uncomfortable. I'm going to try to make it fast."
"Derek, as soon as we pull the vent, I'm going to put a mask on you just to give you a little support for a while. If you don't need it, we'll switch over to nasal cannula." Teddy had the oxygen mask in her hand, figuring he would probably need the support of it over his mouth and nose for at least a few hours.
Derek nodded a bit, closing his eyes. He tried to imagine himself somewhere outside of that room, somewhere with Meredith. He thought about how nice it would be to get back home and rest with her in his arms. It worked, because he missed the counting and the warning of the tube being pulled completely. The next thing he knew, he was jerked out of his peaceful daydream by the painful feeling of the tube being pulled from his chest and out of his mouth. He sputtered, then coughed. A strangled yell escaped his throat at the fire that ripped across his sternum and abdomen, his body screaming in protest at the jerking movements. Then he was gasping, whimpering, and fighting tears.
"Easy, easy. I'm so sorry." Teddy handed him a pillow, watching as Meredith helped him cradle it against his torso, just in case he coughed again.
He did. He coughed again, over and over, until he felt like he was dying. He felt like someone was gutting him, and a couple of times his worn out lungs and bruised vocal cords managed a few weak yells, hands shaking as they clung to the pillow. He was grateful for the oxygen mask Teddy placed over his mouth and nose. He could hear Meredith saying something, but his pain was so intense he couldn't focus on anything but the desperation for it all to stop. He heard Meredith's voice becoming increasingly agitated, and he assumed she'd asked for something because the next thing he knew Teddy was injecting something into his IV and he was drifting off again.
Meredith struggled to slow her breathing down, still holding onto Derek's hand even after the extra morphine and versed pulled him away from her and into a sedated state. "We didn't warn him." Her voice broke, and she began to cry. "We should have warned him. He didn't even have time to know it was coming."
Teddy sighed. She felt responsible for not even thinking about it. "I am so sorry, Meredith." She stood there a moment, watching the monitors to make sure Derek's blood pressure and heart rate returned to normal. "Those meds will knock him out at least a few hours. You really should take this time to go get some sleep, even if you just go to an on-call room. I know you don't want to leave him. But you need to take care of yourself. The nurses tell me you haven't left in over twenty-four hours."
"I can't leave him, Teddy. Not now that he's awake."
"Meredith, you have a baby to think about. Derek would be devastated if something happened to either of you because you were here at his bedside all the time instead of getting the rest you needed." She played that card because she knew it was the only one that had any chance of actually working.
How was she supposed to argue with that? She sighed, glancing back at Derek. "You're sure he'll be asleep for a few hours?"
"I'm sure."
Reluctantly, Meredith agreed to go, leaving Teddy to pull his chest tubes. She ended up sleeping in the on-call room for a couple of hours before going back to his room.
Derek was just starting to stir when she came back, groaning softly as he opened his eyes. Despite everything, he smiled when he saw her sitting there. "Hey," He whispered, still having trouble getting his voice to work right.
"Hi," Meredith smiled, reaching over to take his hand. "How are you feeling?" She wanted to apologize about earlier, but didn't want to remind him of it.
"Like I was stabbed." He hoped to see a real smile on her face, but he frowned when he saw the tears in her eyes. "Meredith."
"It's my fault." She sniffled. "This is all because of me. I knew he wasn't stable. I knew the knife was there. I knew they didn't really need a consult with you. I shouldn't have had you paged. I never should have agreed to it."
Derek struggled to understand her as she cried. "Mer," He brushed his thumb across the back of her hand. "Mer, breathe."
She couldn't stop, couldn't slow the tears. Her sobs turned into gasps as she apologized, over and over, as if somehow that was going to be able to erase everything that had happened. "I'm sorry. I'm so sorry."
"Meredith," Derek took a couple of slow breaths, closing his eyes for a minute. He quickly became frustrated when he realized he didn't even have the strength to say much more, or get his voice to move from the whispered tone. "It's okay, Meredith. Take some deep breaths."
It took a few minutes for her to calm down, even with his reassurance. When the sobs had finally stopped, she wiped the remaining tears from her red and puffy eyes. "I thought you were going to die."
"I know." He said gently, reaching up to brush a couple of lose strands of hair from her face. "I'm right here, Mer. I'm not going anywhere. And I don't blame you." The urge to cough began to build up in him again, and his attention was pulled away from her as he desperately tried to fight it. He knew the agony that would cause, and he didn't want to go through it again.
"Derek?" Meredith frowned, concern clouding her eyes when she noticed the expression on his face.
"Water," He managed to whisper, gasping when the cough came anyway.
She almost couldn't stand to hear the cry of pain that came when his body betrayed him, and she quickly grabbed the same pillow from before, pressing it against his chest. "Deep breaths, Derek. Slow, deep breaths." The tears in his eyes ripped at her heart. She grabbed the cup of water at his bedside and helped him drink a few sips, frowning when he sputtered. "Careful." She could see the frustration flash across his face, and in that moment she wanted to switch places with him. She'd do anything to take away his pain.
Derek leaned his head back against his pillow after taking a few sips of water, his breaths coming short and fast. They only managed to cause more pain, and he quickly wished he could give himself more drugs so he could sleep through it all. He knew Meredith was doing the best she could, and he appreciated her being there, but it didn't lesson how agonizing he knew this recovery was going to be. He tried not to cry, but tears came anyway.
Meredith reached out and gently wiped his tears away, glancing over as Kelly walked into the room.
"Doctor Shepherd," She had on the same cheerful smile as always. "You're awake." She acted like it was a surprise, though it had been easy for her to see through the glass doors to his room. "We need to get you sitting up, even if it's here in bed. This evening we'll work on getting you in a chair."
Meredith bit her bottom lip, wanting so badly to argue. She knew it would only set Derek back though, to be immobile for much longer. The faster he was up and moving, the better he would recover. She knew Teddy was keeping a close eye on his fragile heart, and she knew they wouldn't let him do something that would put him back in the operating room.
Derek took a couple of slow breaths, opening his eyes to look at the nurse. Already so much anger was building inside of him. He tried desperately not to take it out on her, but the frustration of how much his life had suddenly changed was overwhelming. "Don't you think you've put me through enough hell for one day?"
Kelly watched him for a minute as if she was trying to decide how to respond. "I'm doing everything I can, Dr. Shepherd, to get you home with your wife and your son. That's what you want, right? To be able to go home and rest in your own bed? You can't do that if we don't start doing some work. I know this is difficult."
Derek gave up. He knew there was no point in trying to argue. They were going to make him do it anyway. He tried desperately to brace himself for the pain, but quickly realized that nothing could have prepared him for the fire that once again ripped through his torso. He yelled, a bit louder than before, tears filling his eyes once again. The burning didn't subside even after the bed had changed positions and he was forced into a sitting position. It continued despite his best efforts to will it away. "I need something, for the pain. Please." He wheezed, barely able to even form a coherent thought.
Meredith glanced at the clock, doubting there was much he was scheduled to get. She reached over to take his hand, not complaining even when he squeezed her hand so hard she thought he was going to break it.
"We can get you something in about an hour. Until then, just try to take some slow breaths. I know this is painful." Kelly made sure he was okay before she left the room.
"Derek," Meredith finally spoke up when she was gone. "You're doing so well. I..."
"Stop it!" He cut her off, snapping without meaning to. "Just stop, Meredith!"
She jerked her hand back, trying not to take what he said personally, though it was already proving to be a difficult task. "What can I do?" She whispered, bracing herself in case he snapped again.
"Nothing. You can't do..anything." There was a pause. "I...God, I'm so sorry. I'm sorry, Mer."
"I know." She hesitantly reached over and ran her fingers through his hair, gently rubbing his scalp. "Close your eyes." She was relieved when he didn't protest. "Try to sleep."
"Can't sleep, Mer. My chest hurts like hell." He mumbled, closing his eyes.
"I know, I know it does. And I am so sorry. Just a few more minutes and you can have more pain meds. You can do this." She said gently. She was relieved when fell asleep, most likely due to sheer exhaustion.
When she was sure he wasn't going to wake right back up, she got up and went to find Teddy. His pain had to be better controlled if she had any chance of a halfway decent recover, and she wasn't going to sit around and let him hurt any longer.
"Meredith," Teddy was on her way to surgery, surprised when she stepped onto the elevator with her.
Meredith was relieved when the doors closed and they were the only ones there. "Derek's in an incredible amount of pain. I know you were careful, because he was unstable before. But he's getting stronger, and I don't think he's going to be able to get better at all if he doesn't get some relief."
Teddy nodded, agreeing with her. "Since he's been stable breathing on his own and his blood pressure is doing pretty well, we can adjust his meds."
"I'm serious, Teddy. His pain his completely uncontrolled. There's no way he's getting out of bed today if you don't do something. Morphine isn't going to work."
"We can try Dilaudid if you want. But we'll have to keep a really close eye on his respiratory status and the load on his heart."
"I know. And if he gets bad again, we can pull him off of it. But Teddy, please...please put the order in. Or I swear to God, I'll put it in myself, and I don't care if I lose my job for it."
"Meredith," She frowned. "I'm headed to a surgery now, but I'll find a computer and make sure it gets entered before I start."
Meredith nodded, "Thank you." She was relieved it hadn't been a huge fight.
"You should grab something to eat before you go back." Teddy suggested. "Once this order goes in, Kelly can administer a dose for him. He'll be comfortable for a few hours and will likely just sleep. Take this time to put yourself first."
"I have to make sure he's okay first." Meredith insisted. "Then I will."
Teddy knew she couldn't argue with that. She stepped off the elevator, going to put the order in for the medication. She crossed her fingers that it wouldn't cause his breathing to slow significantly.
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*Revised 6/2017