The Fight For Four

Chapter Eleven

Dilaudid quickly became Derek Shepherd's best friend. The change in pain medication had taken him from the depths of hell back to a reality that was manageable. He was still uncomfortable, and still had an incredibly long recovery ahead of him, but he was finally able to rest for a moment without feeling like he would rather die. He was finally able to take a breath without feeling like his lungs were being sliced open. Over the next twenty-four hours he was actually able to make some progress he could feel good about. Despite his body being so weak he couldn't even sit up without help, they'd managed to get him into a chair at his bedside a couple of times. He'd stayed there only half an hour each time before he became too tired to sit any longer, but Derek knew it was a huge victory. His recovery was already ten times harder than it had been after he was shot, but he did his best to put on a brave face and do what he could. The catheter in his bladder had finally been removed, leaving only his central line and feeding tube, both of which he was more than ready to get rid of. Owen and Teddy had both insisted that he wasn't ready yet, and that the repair to his stomach meant it would be at least a few more days before they allowed him anything other than tiny amounts of water by mouth. There were some short discussions about moving him out of the ICU, but nothing definitive yet, though he desperately wanted to move to a regular floor. Leaving the ICU would mean hourly checks would end, and that Meredith would actually have a decent place to sleep. His heart was still weak though, and despite his improvement, they were still having to adjust his medications to help give his most vital organ more help.

"Mer," He looked over at her the morning of that fifth day, studying her for a moment. He'd been so wrapped up in his own issues that he hadn't noticed how tired she looked, or the emotional stress that was written all over her face.

"Do you need something?" She looked ready to jump out of her chair to get whatever it was, concern clouding her eyes.

"I'm fine," He assured her, reaching over to take her hand. Her reaction just proved that the reasons behind his concerns were justified. "I want you to go home today. See Weston, eat something. Get some sleep."

"I'm not leaving, Derek." She frowned. "I'm fine. I'm not the one in the hospital bed."

"Meredith," He brushed his thumb across the back of her hand. "You're exhausted, you're not eating, and you spend all your time worrying about me. I'm fine. We have a baby to think about." He reminded her.

"Derek," She didn't want him to back her into a corner. Tears stung the edges of her eyes. "I can't leave. Please, don't ask me to leave."

"I need to know that you're alright. Right now, you don't look alright."

She knew she wasn't going to win. Her heart sank, and she stared at the floor. "I'll go, tonight, and I'll sleep at home. But just tonight. That's it."

"Okay," He knew it was probably as soon as he was going to get. He smiled a bit, gently squeezing her hand. "You're feeling okay, right?"

She watched his gaze shift to her stomach where a tiny bump was starting to form. It probably wasn't noticeable to anyone else, but she knew Derek could tell her body was changing. "Feeling great." She assured him, though she could see the doubt in his eyes. "I am tired, Derek. But you can't expect me not to be. If our roles were reversed, you wouldn't be leaving me either. You never left, after the accident." She reminded him.

"I wasn't pregnant." He argued, yawning.

She noticed his words starting to slow and the blinking of his eyelids, recognizing his fight to stay awake. A quick glance to the clock told her he'd been awake for half an hour, which was actually quite a long time for where he was in his recovery. "I'm feeling the normal pregnancy stuff." She assured him. "Nothing more. I'll sleep tonight. Your mom's a more strict babysitter than you are. Nothing gets past her."

Derek couldn't help but smile. "She loves you."

"Get some sleep, Derek."

His body wouldn't let him argue with that. Despite his efforts to keep talking, he began to drift off.

Meredith leaned her head back, hoping to rest a few minutes herself. Despite her reassurances to him, she was beyond exhausted. The physical demand of staying there with him and being awake every second he was, the emotional toll of everything, the separation from their son, the lack of eating regular meals, and being fifteen weeks pregnant had taken its toll on her. She knew he was right about her needing to get away for a while, but the thought of leaving him was hard. His progress had lulled them all almost into a false sense of security, but Meredith was a doctor. She knew he wasn't out of the woods by any means. Just twelve hours ago he'd gone back downhill a bit, requiring an increase in the cardiac support meds that they'd managed to decrease over the last few days. The issue of whether or not his heart would function long-term still remained to be seen. Teddy had pulled her aside yesterday to talk to her about it, to voice her concern that despite the repair and successful surgery, she wasn't convinced that it was enough. She hadn't used the word transplant, but they all had it hanging in the back of their minds. Derek's heart had been damaged when he was shot, again when he'd suffered from cardiac tamponade, and now a third time being stabbed. There was a massive buildup of scar tissue which they'd tried to solve in surgery. There were two repaired wounds directly to the organ, and while it was beating, the strength and rhythm of the beats were off. Derek's heart was sluggish. Without the meds he was on, it wouldn't be effective at all, and that's what scared her. She didn't talk about it in front of him because she didn't want him to take on that worry while he was trying to get better. They were in a game of watching and waiting. Either Derek's heart would heal from the surgeries and would get stronger, or it wouldn't. And when dealing with a heart, there weren't any alternatives besides just getting a brand new one.

In the ICU, there was no rest for the weary. Teddy walked in just as Meredith started to drift off. "Sorry to wake you both." She noticed Derek stirring when she spoke. "Just came by to see how the new dosage of meds is working."

Derek forced his eyes open. "I'm doing better." He mumbled, struggling to turn his brain back on. He was tired, so tired. It had been a couple of hours since his last dose of Dilaudid, and the uncomfortable ache in his chest was starting to turn into a fiery burn. Nothing yet unmanageable, but definitely unwelcomed.

"Glad to hear it." Teddy smiled, taking out her stethoscope to listen for herself. She did a quick check of his surgical wounds then replaced the dressings. "I think we need to get you up and walking some, even if it's just to the nurse's desk and back."

"Okay."

Meredith hated the defeat she heard in his voice. She wanted to tell Teddy no, to protect him from the agony that would come with standing up really for the first time since his surgery, but she instead just reached over and took his hand. She knew the best thing she could do for him was support him and encourage him, even if it felt like she was taking part in his torture. "It's only a few feet." She assured him.

"I'll get Peter." She referred to the physical therapist that had helped them move Derek into a chair the day before. "And I'll be back to check on you tonight before my shift ends."

"Any chance I can get rid of this tube down my nose?"

"Food isn't an option yet, I'm afraid. I know it's uncomfortable, but Owen and I both agree we should wait another day or so before we see how you do eating."

Derek nodded, closing his eyes again. He tried to gather up all of the energy he had left, tried to mentally prepare himself for what it would feel like to stand on his own two feet and take a few steps. He wasn't sure he was ready for that. Just moving his leg over took a tremendous effort, his limbs still feeling heavy and weighted. Until his heart got stronger, he knew every physical activity no matter how small would be an uphill battle.

Peter was there not too long later, and managed to get Derek Shepherd to his feet, letting him use the assistance of a walker for support. A white belt, resembling one students used in karate, was around his waist. He didn't pull on it, but it was there just in case he began to fall. With the incision to his stomach, he left it loose, a safety net really. "You're doing great, Dr. Shepherd." At first they didn't move. He let him stand there, adjusting to being upright.

Meredith watched as the color drained from his face, an expression of agony washing across his eyes. She saw the way his hands gripped the bars of the walker as if letting go meant he would crash to the floor. She could see his chest rising and falling more rapidly than it had been in a while, and with each gasp a low groan of pain escaped his lips. She tried not to think about what it must feel like, considering they had cut his sternum in two to get to his heart. They had sawed straight through bone, then forced that same bone to be held open for hours during surgery in order to visualize his chest cavity. A lot of the pain cardiac patients felt at first was from their sternum, and really for the first six weeks until it healed, every breath was hell. Every laugh, every movement, every tear, every gasp..it was like being stabbed all over again. She'd heard patients describe it before. Derek had gone through it before, and it almost killed her to know this was the second time he'd had to endure the torturous pain. She did a quick mental calculation. It was going on three hours since is last dose of pain meds. Dilaudid tended to be long-acting, but as time went on, the initial high from it would start to trickle off. She hated that they hadn't dosed him right before this. "I'm right here, Derek. Try to slow your breathing down. It will help with the pain." She stood next to him, grateful that Peter didn't push, grateful that he at least gave him a chance to relax a little. She glanced to the monitors, noting his oxygen saturation had already fallen a little. She removed the nasal cannula from his nose, replacing it with a soft oxygen mask that fit loosely over his mouth and nose. It would give him a little more support, and she seemed satisfied when his oxygen levels increased a bit.

Derek watched as Meredith and Peter gathered up all of the tubes and wires still connected to his body. It felt so ridiculous to him that they were dragging all of it with them just so he could walk twenty feet or so, but there was really no choice. They couldn't disconnect it and leave it behind, so it was either bring it or not walk at all. As Peter asked him to take a few steps, he quickly wished he had the not walking option. "I..."

Meredith could see his struggle, and his fear. She reached out, resting her hand gently on his arm. "You're doing great. You can do this."

Derek paused after shuffling a couple of steps, his breaths getting heavier, more difficult. He didn't know if he could. He felt like giving up already.

"Dr. Shepherd." Peter stayed right behind him. "I need you to keep going. All the way to the nurses station. Then we'll rest for a minute. When we come back, you can sit in the chair for a bit."

The room began to spin after a few more steps, and Derek became aware of Meredith's and Peter's hands on either side of him. He groaned at the pain the pressure of their touch caused, but was grateful that they hadn't let him sink to the ground. "Room's...spinning." He mumbled.

"I know. I know it is. It's okay." Meredith's voice was gentle, reassuring. They had most everything with them, but the EKG leads monitoring his heart had been disconnected. The blood pressure cuff was left behind, and the oxygen saturation monitor on his finger was no longer there. She relied on her instincts and basic triage skills as a surgeon to tell her whether or not they should keep going. For the time being, she encouraged it.

"Lets keep going, Dr. Shepherd." Peter encouraged.

Derek complied, though by the time he got to the nurses station his legs threatened to buckle beneath him. He was struggling to suck air into his lungs, his chest rising and falling rapidly as his heart pounded against his chest. It hurt. It hurt worse than anything he'd felt in days, and he cried as he stood there halfway leaning against the desk, wheezing against the effort it took just to get oxygen through his body. "Something..." He couldn't put thoughts into words. He didn't have enough air to talk. "...help."

"Your body's adjusting, Dr. Shepherd." Peter assured him. He didn't seem worried.

Meredith assessed, as best she could. She counted his breaths as best she could. Holding his wrist for a second meant she could feel a thready pulse. There was a dusky tint starting to surround his lips. She frowned. "Lets go back. Then you can rest." She wasn't going to freak him out, but she was going to have Teddy paged as soon as he was safely back in bed. Maybe the walk had been too much, but then it was five days out from his surgery, and really, she knew he should be able to handle it. "Slow breaths, Derek."

He tried to comply, but barely managed to change his breathing pattern at all, frustrated as tears continued to fall. They had to basically hold him up as he shuffled back to the room, and by the time they had him settled again he was gasping, his lungs begging for the oxygen they weren't getting. "Meredith..." He tried to get her attention just in case she didn't notice his distress, but there was no worry there. As soon as his EKG leads and oxygen saturation monitor were connected again, the machines screamed their warnings.

"You're okay." Meredith grabbed him a couple of extra blankets from a cart in the hallway, tucking them around him after she noticed how cold his skin felt. She was just about to page the nurse when Kelly walked in.

"I already paged Dr. Altman." She adjusted the flow on Derek's oxygen mask. Both women stood there, staring at the monitors for a minute. "Derek, I need you to tell me what you're feeling. Is it pain? Would more pain medication help you right now?"

"Dr. Altman's in surgery." Meredith's heart sank as the realization hit. Something was wrong, and Teddy wasn't going to be able to come. She could see that Derek had caught on to their concern. He looked at her with wide and desperate eyes for a moment before she found herself able to see only his eyelids.

"Can't breathe..." He mumbled. "Heart's...racing."

"Derek," Meredith stepped to his side, taking his hand. She gently rubbed it. "I need you to slow your breathing down. I need you to take some slow, deep, breaths. I know it hurts, but we need your heart rate to come down."

He tried. Derek tried so hard to do what she said, groaning at the knives that stabbed through him when he deepened his breaths. His sternum screamed in protest, fire ripping through him. He kept going though, trying to copy Meredith's exaggerated movements. It wasn't working, though. Nothing was working. "Help," He mumbled.

"What happened?"

"Cristina." Meredith looked surprised to see her there.

"Teddy's in the middle of a bypass. You're stuck with me." She had her stethoscope out, already listening to his heart and lungs. "This happened out of nowhere? When was his last dose of dilaudid?"

"Three hours ago. We had him walking to the nurse's desk." Meredith was glad Cristina was there. She needed some of her calm, stoic approach.

"I asked if he thought it was pain causing this." Kelly waited for Cristina's instructions.

"It's fluid." Cristina was confident in her answer. "Fluid and just a really crappy effort from your really wimpy heart."

Meredith smiled a bit, though she noticed Derek didn't really seem to be listening to anything they said.

"No more walks, for now." Cristina glanced at Kelly. "I'm going to talk to Teddy, but we're going to have to figure something else out. Five days out, his heart shouldn't be struggling like this. He should be able to do these things. So for now, until we find out what's going on, he can sit up but that's it. I'm going to write for a couple of things you can give him now. Go ahead and give him his dose of pain meds." She stepped into the hallway to get everything entered into the computer.

Kelly was back within minutes, meds in hand. They were quickly given to Derek in his IV.

Meredith breathed a sigh of relief when things finally calmed down. Derek was ripped away from them again and pulled into a deeply sedated state, but at least his vitals were stable. "Does he need a new heart, or not?" She demanded an answer from her friend.

Cristina shrugged. "Too early to say. But I think he should rest for a few days. There's no point in pushing him right now. Sets the heart back, and honestly, he can't afford that. If this was just about him being uncomfortable and having a hard time adjusting, it would be one thing. But his heart was giving out...for what? Like...a six foot walk."

"I know." Meredith was scared but she tried to put on a brave face. She tried to think about how relieved Derek would be that he could rest for a while. She knew he was more comfortable like that, and she hoped some time with minimal pain would help.

Teddy came by that afternoon, basically reiterating everything Cristina had already said. There wasn't much she could disagree with, though Meredith could tell she was more worried than usual. "I told the staff to page me tonight if there's another problem. Owen will be here and I'm off, but I'll come back. Or he can call me." She assured Meredith. "Until Derek can remain stable without the insane amount of cardiac support we have him on, he's not to do anything but rest. I already put it in his chart, but just in case. He can sit bedside three times a day for as long as he can tolerate. But that's it. I know it's going to delay him going home and gaining his strength, but it's not worth the risk."

Meredith left that afternoon like she'd promised Derek she would, though she cried there in the hallway for a good twenty minutes before walking to the elevator. She was terrified that something would happen overnight, but she could no longer argue about how much she needed to get some rest. She missed her son too, and she was looking forward to having a semi-normal night at home.

I know Derek's been stuck for a bit. It just didn't seem right, to me, to rush his recovery after such a serious injury. But, in the next chapter he will finally make some good progress.

Please leave me a review.

*Revised 6/2017