FireCacodemon: Welcome back to another chapter of Trauma Center: A Pathogenic War. The last chapter in Book 2 before we move onto book 3!

Derek: Trauma Center belongs to Atlus, the cover image belongs to Aileen-Rose.

Chapter 20:

The Beating Heart of a Surgeon

Derek hadn't slept that night; he still had to give his answer to the transfer to Caduceus. He could either accept it and move to a new environment and assist in the war against GUILT or he could refuse, stay at Hope Hospital and just wait for what could be misfortune. Could Derek just sit back and let the parasites just take the lives of millions? Gemma had curled up with him for the night and it helped him remain calm but it wasn't enough to help him sleep that night. It wasn't going to be much of a surprise that he had an operation booked today so he was going to have to do that without any sleep. It might be possible for him to have a nap during his breaks but he had paper work to handle...Derek didn't know. Angie and Greg were probably going to be aware that he hadn't slept since they seemed to be keeping a very close eye on him. He looked over at the clock to see that he had an hour before he had to leave for work. He dragged himself out of bed and moved to have a shower. Gemma watched before stretching out where Derek was.

Trauma Center: Calm Before the Storm – Chapter 20: The Beating Heart of a Surgeon

Derek gently knocked on the door of room 207 before entering the room. In the room was an elderly male with dark grey hair, gentle dark brown eyes and a friendly smile on his face. He was back in his grey shirt and brown vest over the shirt. He had recently been discharged and a few days earlier, had a successful operation performed on him. Derek walked over to him with a smile plastered on his face.

"Thank you so much, Doctor. It just hurt so badly...I thought I was a goner." He had a gentle voice which fitted his personality.

"Congratulations on your full recovery."

"It was all thanks to you,"

"Mr. Sasano, we both did a good job in there."

"What do you mean?"

"Despite appendicitis having a fairly common procedure, it was your determination to live which made the difference as well as the speed of your recovery."

"I really like you Dr. Stiles, I like your view...if my wife gets sick, I'll make sure you're the one operating on her!" Mr Sasano started laughing. Derek joined in too before quietening down.

"Heh, well, let's just hope your wife doesn't get sick at all. Right?" Derek asked as he took his glasses off to give them a wipe.

"That's true...You look tired Dr. Stiles?" He asked Derek.

"Hmm? Oh, just didn't sleep well last night. Not even us doctors are immune to nightmares," Derek frowned slightly.

"No one is immune to nightmares. Well, I best be off. Thank you again, Dr. Stiles," Derek smiled and watched Mr. Sasano leave. He watched as the door shut behind him and he found himself gently sitting down on another bed. It gave him time to think before he had to go and see his next patient.

"Talking with patients is probably my favourite part of this job, along with completing operations." He smiled as he gently let himself lay down on the bed. "Could I really leave this behind...?" Derek felt his eyes slowly shutting...

"Derek, we'll be starting the operation briefing very soon," Greg burst into the room making Derek leap off the bed with a start.

"I'm awake!" Derek said, startled.

"Derek?" Greg asked concerned. "Are you feeling okay?" He asked Derek.

"Yeah, yeah, I'm okay."

"You look exhausted, can you handle the operation?"

"Yes, I'll be ready for the operation," Derek picked himself up and made himself look presentable.

"I'll be watching you to make sure then," Greg told Derek before the two of them went to grab Angie and then start the briefing.

Trauma Center: Calm Before the Storm – Chapter 20: The Beating Heart of a Surgeon

"Today, you'll be operating on Elisa Chalke, from paediatrics," Greg informed Derek and Angie as he handed the file to Derek with Angie reading over his shoulder.

"She's a very young child with valvular heart disease..." Derek said as he read through the file. Mitral prolapsed and regurgitation. Since complications may arise, it is necessary to replace the valve with a synthetic valve. Derek was aware that it wasn't going to be an easy operation but he was happy to take on new challenges. If there were any complications while working on the heart, then Derek was just going to massage the heart to get a rhythm instead of relying on the defibrillator to recover the pulse. It was probably better for the defibrillator but Derek found it better massaging instead.

"It was a very tough decision, but her parents have finally decided to go ahead and have the procedure done." Greg looked at Derek. "There's only one main objective for this surgery: Replace the valve in her heart with a synthetic one."

"I'll perform a triple incision to excise the valve, with the chance that her heart will threaten an arrhythmia but with the defibrillator as well as my own hands, we can recover the pulse once more. I'm also understand that there's going to be a lot of haemorrhaging when operating too I'll remove all overflowing blood before continuing and step back when the vitals show an irregularity," Derek said and Greg nodded. Angie watched the two while mentally preparing herself with what she was going to have to do.

"You'll need to be as cautious as possible, understand?" Derek nodded. "Technology has allowed us to deal with all kinds of situations but heart surgery will always rely on a doctor's skill. Angie, I would like you to also keep an eye on the oscillograph to aid Dr. Stiles."

"Yes sir, I understand." Angie smiled

"Don't let the gravity of this operation intimidate you. That concludes our conference. She's in your hands now, Derek."

"Right, let's begin the operation!" Derek struck his pose once more.

Trauma Center: Calm Before the Storm – Chapter 20: The Beating Heart of a Surgeon

"Her report details frequent occurrences of light arrhythmia. Be ready for the unexpected, just in case. Apart from that, let's begin," Angie informed Derek as she handed him the antibiotic gel. Taking the gel, Derek disinfected her chest and made the incision. He opened up the body to reveal the heart. Everything looked fine on the outside but nothing was okay if an operation was needed. Derek applied gel onto the heart for the disinfection before he grabbed the scalpel and made another incision to reach the valve inside the heart muscle. Before he made the incision Derek heard the steady beating of the heart dramatically increase. "What? The electrocardiogram is showing an abnormality!" Angie alerted Derek, he stopped what he was about to do and took a moment to step back, he would cause more damage if he tried to continue the operation. "She's suffering ventrical fibrillation!" Angie shouted as she watched Derek. He was busy putting antibiotic gel onto his gloved hand before reaching in for the heart to start massaging it. Greg and Angie watched as Derek massaged the heart until the fibrillation passed.

"It's a shame to see such a young child having to go through a high irregular heartbeat like this..." Derek said once the heart had returned back to the average heartbeat. Angie nodded.

"There's a strong chance that her heart will continue to go into convulsions, when you feel that happening, hold the operation," Angie informed Derek who nodded.

"I agree, if she goes into another convulsion, we'll use the defibrillator," Derek informed Angie.

"I'll get it ready for the next time. Continue with the operation, Doctor," Greg informed the pair of them so they could focus on the operation more than letting Angie worrying about something else.

"The defibrillator may have a high success rate, but allowing the heart to flat line repeatedly is obviously very dangerous for the patient."

"I'll continue," Derek said as he re-sterilised the heart but made the incision without any issues. Derek opened up the heart to reach the valve inside. Angie handed him the magnification took so that he had a better sight of the atrium. There was already so much blood that it needed to be drained right away before Derek had a clear vision on the valve itself. Once Derek had clear sight of it, he proceeded to perform the excise. Once the blood was drained, Derek heard the pulse of the heart quicken and paused for a minute, picking up the scalpel in the process. Thankfully the heart didn't go into another convulsion and was able to excise the left side of the valve and moved onto the right side. Making his incision there, a blood pool formed, obscuring Derek's vision. Angie handed him the drain and the blood was removed but the pulse had started to quicken. Derek placed the drain and scalpel down before they needed to get the pulse once more. The operation was half-way done and Derek was determined to finish up.

"Vitals are critical!" Angie informed Derek as Greg came in with defibrillator, the pads were in place and the machine was charged up.

"Charging...Clear!" Everyone stepped away from the child as Angie released the charge to the patient. Derek looked at the monitor to see that another charge was needed.

"Charge again!" Derek ordered, Angie nodded and she charged up the machine once more.

"Clear!" The charge went through and her heartbeat had returned to normal once more, the haemorrhaging had formed once more. That was to be expected though. Derek moved the magnification tool back and drained the blood quickly. Grabbing his scalpel, he made the third incision around the valve, Angie handed him the forceps and Derek removed the valve from her heart. Very quickly the heart was going into another convulsion, Derek removed the tools away and applied his hand with gel, he was going to quickly massage the heart back into a steady beat, drain any blood and then swiftly put in the synthetic valve and suture it in. If all went well, they wouldn't need to use the defibrillator again this operation. It worked like a charm. The new synthetic valve was in and sutured in, there was the threat of another convulsion but thankfully it had been avoided. The heart had returned to normal once more. Everyone breathed a sigh of relief.

"You're getting better at suturing," Greg commented.

"The valve transplant is complete. Let's finish up here." Angie smiled as Derek removed the magnification tool away and proceeded to suture up the heart.

"Now she can play outside with all of her friends when she recovers and returns back to school," Derek smiled when he finished suturing up the heart. He felt so relieved that she was going to be okay now and her parents weren't going to have to go through the death of their child. "I want those vitals up though," Derek pointed towards the vital count. They were at twenty-eight. Not a number that he enjoyed seeing when the big number was ninety-nine.

"Here's some stabiliser," Angie smiled as she handed him a syringe filled with the green liquid. Three injections were needed before Derek was happy with the vital count. A stable sixty-six before Derek sutured up the incision made. The gel was applied and then the bandage. The operation was a success.

"Poor girl...she's too young to go through something like this..." Angie frowned as she looked down at the patient's young features.

"Having someone cut open your chest is so unnatural..." Derek sighed in relief. "But her little heart refused to give up and that's what really impresses me."

"It does?"

"For children to go through this...it must put a lot of stress on the developing body. Maybe this just sounds silly but recently I've been thinking about it...The human body truly is an amazing thing."

"The both of you worked hard, you two both deserve some rest," Greg smiled. "I'll take over from here. If I see that either of you are working then you'll be punished," Greg laughed before they all left the OR, the nurses took the patient back onto the ward.

"Is my daughter...Will Elisa be all right?" A very concerned mother asked Derek as he walked onto the ward.

"The operation was a complete success, Elise will need about two months to fully recover before she can go back to school, after that though, she'll be as good as new," Derek informed her with a smile on his face. Angie smiled too but noticed Derek's smile...wasn't quite real. It was getting better but she had noticed small behaviour changes in Derek.

"That's good new...Thank you so much Doctor!" The mother suddenly burst into tears of joy, knowing that now her child was going to be okay.

"You should be thanking Elise too, for not giving up."

"I will, of course!" She smiled as Derek escorted her to Elise's room.

"People are always worried about having heart surgery, especially if a child is involved. But modern medicine allows us to treat various conditions with a high success rate than ten...maybe even just five years ago. Young patients like your daughter face very little risk of permanent physical damage," Angie spoke with confidence. She wasn't wrong, with the advancements, nearly anything is curable.

"If I'm being completely honest, I'm more worried about the psychological stress operations like this might have on small children. Please take good care of her while she goes through her recovery," Derek smiled.

"Oh, of course I will. Thank you again." She turned to her child. "Elisa...We both love you so much..."

"Modern medicine...huh...?" Derek turned to leave; he was going to get that nap he badly needed. Angie watched him leave before she headed to the staffroom. She would have to check on Derek later but for now, they both needed a well deserved rest. "Things really have come a long way..."

Trauma Center: Calm Before the storm – Chapter 20: The Beating Heart of a Surgeon

"I'm very sorry...Modern medicine just hasn't advanced enough to treat a disease like this..." Derek (age four) felt tears rolling down his face. This was his own father and they couldn't save him? He heard his mother crying from the news, the doctors looked sorry for her while Derek just let the tears fall down his face, he couldn't help his dad and neither could the doctors...He clutched onto his father's clothes for dear life.

"No, daddy! You will get better!" Derek cried before he felt a hand gently ruffle his hair. He looked up to see his father's smiling face...Yet his eyes were screaming from the pain he was feeling. "You have to get better! You promised we'll go to the zoo...to play dinosaur...the park...you promised!" Derek screamed his lungs out. He wasn't sure what the doctors were feeling.

"Derek...listen...there'll come...a time...when things...like this have...to happen...this is...this is life...You'll learn...that when you...grow older..." Arthur told Derek as he weakly wipes Derek's tears away from his eyes. "You...have to...be strong...for everyone...can you...do that...?" He asked Derek. Despite Arthur gently rubbing his tears away, more tears quickly filled its place.

"You have our condolences..." the doctors gave the three of them some space. Derek watched them leave before looking up at Arthur.

"You're going to be okay!" He yelled as Delilah gently picked Derek up and placed him on the bed next to Arthur. Arthur smiled down at his son and pulled him into a hug. It was a weak hug but the warmth was still there.

"Son...look after your mother...for me?" Derek frantically nodded.

"I'll be the best son you've ever had!"

"You're...our only son..." Arthur chuckled.

"I'll make you proud...Dad, I'll become...a *hic* doctor...so that no one...will have to... *hic* go through...!" Derek couldn't finish. He couldn't bring himself to admit that his dad wasn't going to get better. He wasn't going to admit that his father was dying. Delilah joined in the group. The three of them remained together for a long while. A few weeks later...Arthur passed away...

Trauma Center: Calm Before the Storm – Chapter 20: The Beating Heart of a Surgeon

Angie arrived in the staff room and moved towards the staff bedding room where she expected to find Derek. Gently knocking, she pushed open the door and walked inside. There were a couple of beds lined up in the room so that multiple members of staff could rest and take a nap. She scanned the beds until she found the familiar failed-to-tame brown hair of Derek. Walking over, she stopped when she heard him sniff like he had been crying. Her heart sank, there was something bringing Derek down and he didn't tell anyone? She slowly approached his bed and gently took a seat on the bed. She watched as Derek's shoulders jolted upwards and tears were rolling down his face. She placed her hand on his shoulder and gently shook him.

"Derek...it's okay..." She spoke softly, not wanting to startle Derek to the point where he could easily hurt himself or her if she wasn't careful. After a few gently shakes, Derek woke up. He looked at Angie and quickly wiped his eyes.

"Oh...hey Angie..." He sounded upset that Angie wrapped her arms around him and pulled him into a hug. "W...wha?" he asked confused.

"You need this..."Angie whispered into his ear. She was right, he did need this. Derek wrapped his arms around her and held her close as he gently cried on her shoulder. She didn't ask him what caused this; she just remained there, motionless, letting him cry all his tears onto her shoulder while she gently rubbed his back in a soothing manner.

"Thank you..." Derek gave his thanks to Angie.

"No problem," she smiled.

"I need...I need to talk to Director Hoffman."

"Are you ready?" Angie asked. Derek nodded and pulled away from her. "Well, good luck."

After a short walk to pull himself together, he gently knocked on Robert's door. After hearing his name being called as well as the word "enter" Derek pushed down the door handle and walked inside.

"Derek, what can I do for you?" Robert asked him.

"Dr. Hoffman, I'm going to accept the offer from Caduceus," Derek told him without any hesitation. The dream reminded him of the reason why he became a doctor in the first place.

"So, you're willing to throw away your own happiness for this?" Robert asked Derek with a serious expression on his face. Derek nodded.

"I became a doctor so that no one else has to be told their disease is incurable. That was the main reason why I became a doctor. Also, with the threat of GUILT, I can't just sit back and watch as others struggle to cure GUILT victims when I can help stop it. I don't know what happened to you in the past and knowing that having the Healing Touch will only result in more pressure...that everyone will expect me to have answers nobody else has...I can't just sit back and not help. I may not have control over the Healing Touch yet but I'm determined to gain control over that power and only use it if necessary. I want to become a surgeon who's proud of their own skills instead of relying on some super rare gift from the God of medicine himself. I'm sure your concerns are valid and the path I've just chosen will probably cause me a lot of pain...but if it means I'm going to be walking the path that I want...I'd take that path."

"..." Robert watching quietly, he was sounding a lot like his father even if he didn't know it.

"Diseases are painful but losing someone to a disease is even more painful. It's hard for doctors to tell people their loves ones can't be cured. I'm going to Caduceus to make sure that they won't have to. With Caduceus already finding ways to save thousands of sick patients...If I can somehow help treat the "incurable" diseases, then...Caduceus is the next step I need to take to further my medical career!"

FireCacodemon: And that's the end of Book 2. The Special chapter will be coming out soon.

Derek: Special Chapter will be out 01/10/2016. Book 3 will start on 04/10/2016.

FireCacodemon: RandomButLoved - I do have plans for more Tyler, Amy and Derek scenes in the future. So look forward to them. :D

Derek: Resting Deeply - The ability to slow down time isn't something people should have so it kinda makes sense not to grasp it straight away. But since it's a game, it makes sense to give the player that ability if the operation isn't going as smoothly as they wanted it to. I like the way FireCacodemon's handling it too but I don't know when I'll finally be able to grasp it. *Shrugs* Time will tell, huh?

FireCacodemon: And that's it for now. We'll be back again in a few days time. Bye!