Chapter 26

Mending the Brokenness

Upon arriving in the Pit, Alex saw Hunt at the main desk, and announced, "I was paged. Where's the patient?"

"What took you so long?" Owen asked more with curiosity than judgment.

"I … was… uh… tangled up in something pressing. Took me awhile to get free," Alex explained.

"Oh," Owen answered, not sure at all what Alex was saying. "We paged you for Bed 7 – adorable kid with broken arm. We'd normally just call Ortho, but he also hit his head and is complaining of abdominal tenderness. Seemed best to have Peds oversee the case."

Alex nodded and felt horribly guilty for making a little kid with a broken arm wait for him so he could finish having sex. He tried to erase the picture of the on call room rendez-vous from his mind by shaking his head a few times as he grabbed the curtain. Offering his well-used introduction that came out of his mouth without effort after all these years, Alex said, "Hi. I'm Dr. Karev. What seems to be the problem?"

As Alex spoke, he looked up and saw Matt. Erin was sitting in a nearby chair with her legs dangling while two older but still little kids sat on the bed. The girl's eyes were glued to a smart phone and the boy was obviously the patient.

"Mr. Karev, MD!" Erin yelled as she bounced down and hugged Alex's leg.

"Oh, uh, hey, Matt," Alex said as he blinked his eyes, confused to be encountering a group of Bauer children in the ER. Then with glee he reserved only for young patients, Alex knelt down and held up his hand for a high five, "Hi Erin!"

Erin shook her head with great solemnity, "Not now. If I hurt your hand like last time, maybe you couldn't help my bro bro." She pointed up at her brother on the bed as Alex chuckled softly and lowered his hand.

Alex stood to approach Matt's younger brother as he removed the ice pack, "Dude, that looks like it really hurts." Chris' arm was already swollen and bruised, and Alex was perturbed, thinking privately, This should have been an urgent page. Poor kid.

Christopher looked up at Alex, trying to be tough, "Maybe a little."

Alex smiled and said, "Just a little, huh? You must be pretty strong. What's your name tough guy?"

Christopher, sounding like an adult, told Alex, "Christopher Dean Bauer."

Grinning, Alex nodded and responded, "So Christopher Dean Bauer, do you want me to use your whole name or call you Chris?"

"Chris or Christopher is fine. I answer to both," Christopher said with maturity beyond his years.

Alex looked up at Matt, who he had not seen since happier times when he gave Matt permission to give Charlotte a promise ring. He asked him, "So what happened?"

Matt said, "He bit it at the end of the driveway. We were sledding and his sled tipped and kept moving without him. He messed up his arm and bumped his head."

Alex pulled up a stool and was examining Christopher as he listened. He handed Elizabeth his pen light and quickly nodded toward Matt to confirm he'd heard him. Then, looking at Elizabeth, he said, "You want to help me examine your brother?"

Elizabeth nodded eagerly and grinned mischievously, "Do I get to give him a shot?"

"I want to meg-zammen him!" Erin insisted as she pulled on Alex's lab coat.

Alex laughed. "How about if you sit on this knee instead, Erin." Alex patted his leg. Erin climbed up and held her arms around him in an ongoing embrace.

"I'm sorry, Dr. Karev," Matt offered out of embarrassment as his sisters vied for Alex's attention, "I can keep these two occupied and take them off your hands."

Alex frowned and shook his head, "I'm good." Alex turned to Elizabeth and said, "And what's your name?"

Lizzy answered using her full name, proud about her important new role as a medical assistant, "Elizabeth."

Erin piped in, "That's only when Mommy's angry. We call her Lizzy."

"Be quiet, Erin, or I'll make up a name for you," Lizzy threatened.

Matt snapped his fingers and cleared his throat. That was enough for both girls to quiet down.

Alex widened his eyes as he continued examining Chris, looked at Matt and said, "Impressive." Matt shrugged his shoulders and grinned. "Does that work on Charlotte?" Alex joked.

Matt smiled and shook his head, "No, she doesn't care if I take away Dora the Explorer if I have to do that twice." Alex chuckled and remembered why he liked Matt.

"Ok, Elizabeth, I need you to hold that shiny light really carefully and point it over here," Alex said as he pointed above the bed. He didn't really need her help, he was trying to distract her as he palpated Chris' fracture.

Alex hit the sorest spot and Christopher tried to hold back tears as he yowled, "Owwwww."

"Sorry, Chris. I had to do that," Alex said as he put the ice back on the break. Alex tilted his head and grimaced. "Where else do you hurt?"

Christopher shared, "Here on my head and on my stomach. Just kind of on my tummy. But not bad."

Looking at the clock and noticing it was lunch time, Alex asked Matt, "When did he eat last?"

"He's probably hungry. Not since breakfast around 8," Matt reported.

Erin offered her earnest observations as if reporting on the sinking of the Titanic, "Mr. Karev MD, Chris is always hungry."

Hugging Erin with one arm, Alex touched Chris' hand and asked, "Can you feel that?"

Chris took in a brave breath and said, "A little."

Alex lied and commented, "That's typical." Then Alex instructed, "How about moving your fingers, hand or wrist? Can you try that?" Chris could barely move any of them.

Alex explained, "Some of my friends will come over to look at that bump on your head. But, first, I'm going to give you some medicine to take away the pain and then let's get some pictures of your arm. We'll see what we've got going on." Alex embraced Erin so he could safely roll back and peek around the curtain. He saw Danielle Rosen and called her over, "Rosen?"

Danielle and her intern came over and Alex filled them in, "Dr. Rosen, let's keep ice rotating on and off, and get ortho down here STAT. Start with my wife, but give Torres a heads up that you might be calling her down. Start oxycodone 0.2 mg/kg. We also need an x-ray of Christopher's left arm – let's get full arm, upper and lower films, all angles – wait for meds to kick in before putting him through that. Do a simple neuro work up before the meds. If you spot anything worthy of it, hold the oxy and page Neuro – I'm not seeing anything now but you need to assess as well. Pretty sure abdominal tenderness is connected to lunchtime, but assess it and see what you think. Even if he is just hungry, NPO until Torres weighs in. Find me when you have the films or if you notice any other concerns." The intern quickly jotted copious notes, knowing Rosen might ask about the case later. Matt watched as his head spun at all the details that Alex so easily rattled off.

"Why oxycodone rather than codeine?" Rosen asked.

Alex raised his eyebrows and lowered his chin, "Good question for you to research. I'll see what you've found next time we talk. Are you free to scrub in? This would be good experience."

"Sure, Dr. Karev." Danielle responded. "Any other orders?"

"I think we're good. Start an IV, do a basic neuro now then let's get him the meds. Ask about allergies first, remember to calculate Peds dosage at 0.2 mg/kg. Call me if you need to confirm any hunches. You'll want to explain each step to him as you go – you've done Peds? I can't keep track," Alex asked.

"Yes with Dr. Robbins," Danielle confirmed. "I'll do the evals and IV while we wait at X-Ray." Alex nodded in agreement. Then shifting into Peds mode, she turned to Christopher and explained, "Hey Christopher, I'm Dr. Rosen and this is my pal, Dr. Davis. We are going to go get pictures of the bones inside your arm."

Erin, Lizzy and Chris all widened their eyes as Chris said, "Cool."

Danielle stepped on the brake release, then she and Davis began to push the bed. She asked Chris, "But first, you get a ride. What's your favorite car?" Chris and Danielle chatted it up as they headed to x-ray. Danielle took Chris' mind off the pain by having him imagine he was driving his favorite car through the hospital and that she and Davis were his pit crew.

Alex supported Erin on his hip as he stood up. Then he reached out his other arm to help Lizzy onto the floor. Holding his forearm in front of her, Alex instructed, "Grab it and hold on tight." She grabbed on tentatively. Alex initially pulled her up just for fun and let her hang in the air as she held his arm. Then he slowly lowered her down until she was standing on the floor. Both girls giggled. Alex motioned for Matt to follow him and asked, "Where's your mom? You need to call her so she can consent to treatment and fill out forms."

"I can take care of all that, Dr. Karev. Mom had this put together when I turned 18 so there are two of us who can deal with emergencies," Matt responded, showing Alex a Power of Attorney and a paper with medical insurance information, allergy information, and medical histories for each Bauer.

Alex glanced quickly and said, "Wow. Ok then. I'll send an admissions clerk over." As Matt and his sisters sat down in the waiting area, Alex awkwardly asked Matt, "So… uh … how have you been, Matt? Been awhile since we've really talked."

"Ok, Dr. Karev. It would be good to talk sometime, huh?" Matt asked nervously.

Alex pursed his lips and nodded sharply, "Yeah. Not now though."

"How's Charlotte?" Matt asked longingly.

Alex raised his eyebrows and bore into Matt's eyes, saying, "I'll check in with you soon about your brother." Then he turned to Lizzy and Erin, saying, "Thanks for your help, ladies."

As he began to step away, Erin grabbed on to Alex's leg and whined, "Please don't leave!"

Alex grinned and held his hand out to Erin. She grasped it, freeing his leg and enabling him to kneel down. "I wish I could stay, kiddo, but I need to help some other kids. Stay here with your brother and I'll come back later," Alex assured her as he kissed the top of her head.

Alex decided he would head up to the Attendings' Lounge to check in with Charlotte. On his way past the desk, he saw Kepner. As far as Alex knew at this point, the pregnancy test from last night belonged to Jo and he'd made an incorrect assumption thinking it was Charlotte's. Without the benefit of the knowledge Jo gained earlier in the morning, Alex approached April.

April looked up from her tablet, "How's Chris?"

"He'll be ok. I'm waiting on films to look at the break. It seems surgical. I'm pretty sure the rest of his complaints are nothing serious," Alex shared. "Hey, Kepner, do you have a second?"

Looking surprised, April said, "Ummm…sure."

Jackson had just finished a consult and was hoping to take his wife to lunch. He walked up and put his arm around April as he greeted Alex with a nod.

Alex began uncomfortably, "Kepner, I… uh… it's been cool how you've talked to Charlotte about church and sex."

"I care deeply about her, Alex. Both Jackson and I do," April shared as Jackson nodded.

Alex admitted, "I have to tell you that I used to think all that purity ring crap was stupid propaganda. But, really, it might be helping Charlotte decide not to spread her legs. So…yeah, April." Alex patted April's shoulder, nodded with an awkward smile, and stepped away.

April looked at Jackson with her mouth agape, non-verbally sharing her befuddled shock at Alex's words. When Alex was out of range, she mumbled softly, "He's always so crude."

Jackson laughed softly, "But there was definitely a thank you in there. A big thank you. You just need to speak Karev to hear it. It's a specialized, unique language only few have learned." Jackson leaned down and kissed April on her cheek as he praised her, "Let's go grab lunch, huh?"

Alex grabbed his cell and called Jo. The more he thought about it, the more sense it made for he and Jo to have lunch and connect before he, or both of them, talked to Charlotte. As they spoke, he also mentioned Chris' case and gave her an overview of it.

While Alex was in the ER offering obscure gratitude, Charlotte was curled up sound asleep in Matt's P-coat on the couch in the Attendings' Lounge. Derek walked in and smiled when he saw Charlotte cuddled up asleep. He walked over to the fridge to grab a water and heard a sleepy voice coming from the corner of the room, "Hi, Dr. Shepherd."

Derek turned his head and smirked. "Hi Charlotte. Did I wake you up?"

"No," Charlotte answered. "I just woke up and saw you over there. I need to get up anyway – my dad and I are going to have lunch together."

Derek nodded as he grabbed a stray chair and asked, "Do you have a minute?"

"I think so," Charlotte guessed.

"Listen, I don't know the whole story and I really don't need to know it, but you put me in a bind last time you babysat," Derek said seriously as he pursed his lips and looked at Charlotte.

"Yeah?" Charlotte responded, unsure what to say.

"I think we both know that when you asked if a friend could come over, I didn't realize you meant your boyfriend," Derek offered. Charlotte nodded uncomfortably as Derek continued, "Between you and me, I told everyone that you did ask if your boyfriend could come over. I don't know if that helped you out at all, but I did it because I think you're a good kid who just gets in her own way sometimes."

"Thanks for trying to help me out. You didn't have to do that for me," Charlotte offered.

"Once was no problem, but don't put me in that position again, Charlotte. Understood?" Derek looked at her seriously but with a kind grin.

"I won't. I apologize, Dr. Shepherd. I'm really sorry," Charlotte gushed.

"Apology fully accepted," Derek declared. "I know you have other adults in your life, but I'm here if you ever need me to lend an ear. Being a teenager can be rough." Derek looked at her with his soft blue eyes. Charlotte's mixed emotions of infatuation, regret, and relief simultaneously bubbled inside her.

Charlotte smiled and said, "Thanks. I hope you'll ask me to watch your kids again sometime and give me a chance to earn back your trust, but I understand if I've blown it."

Derek stood up and smiled. He headed over to the couch and patted Charlotte's knee, assuring her, "You haven't blown it. How about Saturday night? Meredith is on call and I'm having dinner with an old friend."

"Let me double check with my dad," Charlotte explained as she thought, Yeah, my dad, who may never let me out of his sight again once he knows Matt and I have been having sex. She continued, "Again, I apologize. Thanks for giving me another chance," Charlotte repeated.

Derek shared a reassuring grin and excused himself, "I need to check on a patient."

Once Derek left, Charlotte breathed a huge sigh of relief. She kicked back on the couch while she waited for Alex, imagining how wonderful it would be if Alex was as calm, forgiving, and understanding as Dr. Shepherd.

Just a few minutes later, Alex came in and interrupted Charlotte's day dream about ideal fathers who look like Derek Shepherd and never lose their cool. He announced, "Hey, Spider, change of plans."

"Yeah?" Charlotte asked, "What's up?"

"Two things. Your mom and I are going to have lunch, just us," Alex reached into his wallet and grabbed a $10 bill, "so go ahead and grab yourself something."

"Ok," Charlotte responded with relief at the delay in having to face the music. "You said there were two things?"

Alex looked at her with confidence, "Don't flip out because everything is ok, but Matt's little brother broke his arm and Matt's waiting down in the ER with his little sisters. Even though I'm pissed at you and even though your mom will probably be pissed at me for suggesting this, why don't you go hang out with him and help him out."

"OMG, is Chris going to be all right?!" Charlotte said with a tinge of concern.

"I said don't flip out," Alex repeated while rolling his eyes. "I'm waiting on x-rays, but he'll be fine even if the arm needs attention." He consciously chose 'attention' instead of 'surgery' so he didn't have deal with a panicked daughter. Alex headed back down to the Pit to check on Chris' status.

While Charlotte received forgiveness from Derek and news from her dad, Rosen and Jo were in the Pit examining Chris' x-rays. Rosen didn't fully understand what they showed, but Jo was quite concerned.

Rosen reported as she put the x-rays on the illuminator, "The films just came back. He has a displaced fracture. With that and these cracks on the humerus, would this be considered comminuted?" Rosen asked.

Jo shook her head slowly, "Great question. Since the bone is in two pieces and not more, it is not comminuted. Those cracks are concerning though. That break is an oblique fracture. I'm concerned this might be an open fracture, too."

"But there's no exit site. The bone is still inside the arm," Rosen pointed out.

"Right, but see the pooling there? I think this bone broke through lower layers of skin and receded back into the wound. An open fracture is not always visible through the skin. This kid took quite the spill and needs to be on some serious antibiotics while we page Torres and wait for her. Get a CT so we have a better sense of what we're dealing with, then have Torres analyze it all. Any nerve damage? Can he move his fingers at all? How's his peripheral pulse?"

"Finger movement is slight, but highly painful…" Rosen began as Torres approached and invited herself into the conversation.

"Oh man, that's nasty," Torres commented as she took a sip of coffee. "Which one of you can I thank for this early Christmas present? This surgery is going to be a fun one."

Jo smiled and nodded toward Rosen.

"Dr. Karev, the other Dr. Karev," Danielle began.

"Yeah," Callie said, "I call them Boy Karev and Girl Karev." Callie turned to Jo and observed, "It would have been so much easier if you'd kept 'Wilson'." Jo just grinned.

Danielle continued awkwardly, "Dr… umm… Boy Karev asked me to run the tests after he performed the initial exam. Dr. Hunt wants Peds overseeing the case. I paged this Dr. Karev… Girl Karev… for her input," Rosen explained.

"Ok, looks like we're operating this afternoon. Who's running the case?" Torres asked.

Jo added, "As much as I've love to be in there, this is Rosen's surgery. She's done a great job working through each step."

"It's your lucky day, Rosen. Not only do you have a resident who isn't going to swipe your surgery away like her husband used to do to people, you're going to assist on a surgery we only see 3% of the time in children," Torres stated. "Do we need to let Boy Karev know the plan? 'Cause this kid needs surgery now. Where are his parents?"

Jo interjected, "This is one of Dean Bauer's children. Mom is unreachable but oldest son, Matt, has P of A. Matt has been trying to get a hold of his mom."

"The Dean Bauer? As in the one who died last year in that terrible crash? Wow," Torres commented. "That doesn't make me anxious at all."

Jo offered, "For what it's worth, Alex and I know the family. The big brother is Charlotte's boyfriend."

"Go, Charlotte," Torres offered showing she was impressed.

Callie paused as she studied the x-ray and commented, "I'll need a CT and maybe even an MRI. We'll need consent. If we've only got big brother and he can give the go ahead, let's go talk to him. Rosen, get Boy Karev down here STAT. He and I can talk to the family. How's the kid's pain?"

"Dr. Karev…Boy Karev," Rosen said uncomfortably, "ordered oxycodone. Patient's tolerating it well. Pain seems well controlled." Unbeknownst to Callie, Alex had approached from behind and was looking at the x-rays in amazement while the others talked.

"Oxy? Really?" Callie asked with confusion. "I would've gone with codeine."

Alex inserted himself into the conversation and said, "Yeah, you don't want to do that with Peds cases. Have you had a chance to learn why, Rosen?"

"I haven't, Dr. Karev," Rosen admitted without offering an excuse. She knew if she tried to explain how busy she'd been, the attendings would interpret it as whining.

Alex offered smugly, "Morphine intoxication. Ultra-rapid metabolism of codeine in kids can lead to a toxic and even lethal accumulation. There's too much variability in inter-individual response with codeine. Pain relief provided by oxycodone is not dependent on metabolism by CYP2D6. Dig deeper than that, Rosen. Interesting stuff to learn about."

"Well aren't you Dr. Caught Up on Journal Reading?" Torres teased.

Alex shrugged and offered, "Morphine is also an option, but I've been more impressed with oxy's efficacy."

"Shall we go talk to the family?" Torres asked.

"Sure, but I haven't been updated since my initial exam. Where are we at and what's your surgical plan?" Alex asked.

Callie answered, "I'll fill you in on our way to the waiting room. A few quick bullets will catch you up."

Alex looked at Jo and said, "Lunch right after I talk to Matt?"

Jo nodded and said, "I'll meet you in the cafeteria."

Callie provided an overview as they walked to the waiting area. When Erin saw Alex, she came running toward him at full speed with her pet name for him, "Mr. Karev, MD!" He picked Erin up in his arms and then said hello to Lizzy.

Callie laughed and mumbled, "I like that. That just might stick. Mr. Karev, MD…hmmm." Alex grimaced and rolled his eyes at Callie, then suggested they all go into a consultation room.

The group entered the room and sat down. Alex said to Matt, "Matt, this is Dr. Torres. She's an orthopedic surgeon. Have you had any luck reaching your mom?"

Matt shook his head, "I've been trying. She sent a text and told me to go ahead with whatever you suggested. The storm has messed with reception, and she can't get her phone to call out. She's on her way."

Then Alex declared, "Well, I'm suggesting what Dr. Torres is going to describe to you. Charlotte is on her way down here. How about if I take these two Princesses to get some lunch and you can send Charlotte to get the girls when you see her?" Alex glanced at Callie to confirm, "You can cover details with Matt?"

Callie nodded and agreed. She began to fill Matt in on the results of the x-rays and her plan for surgery. As Alex and the girls left the room, both she and Matt heard Erin say, "We are not real Princesses. You know that, right?"

Alex headed to the cafeteria with the girls, relishing every minute of carrying Erin around and holding hands with Lizzy. I can't wait to have little kids of my own, he thought.

Jo giggled as she watched Alex balance a tray and help the girls pick out food for lunch. A part of her knew she should go help, but another part of her was too enchanted and entertained by the site of Alex fathering them along. Alex came over with a tray full of food, Lizzy carefully carried two lidded drinks in her hands, and Erin came skipping through the room without a care in the world.

"You must be Elizabeth," Jo said as she helped Lizzy with the drinks and put them on the table.

Lizzy smiled and asked, "Are you Charlotte's mom?"

Jo looked up at Alex thoughtfully with a confused face. Alex answered, "Yep. This is Charlotte's mom. She's a doctor here too." Alex began setting everyone's food out on the table and emptying the tray.

Erin gently pushed Jo's arm and said, "Do you remember me?"

Jo giggled and caught Alex's eye as she responded, "I know the face. Hmmm… name…. Don't tell me! No hints… Your name is Zelda, right?"

Erin cracked up and declared, "No! Guess again."

"Ok," Jo continued as she winked at Lizzy to let her in on the game, "It's… Madeline." Alex smiled as he watched Jo. Seeing her face light up as she interacted with the girls melted his heart.

"Oh my word," Erin said, likely imitating her mother's exasperated voice. "Nope."

Jo narrowed her eyes and scrunched up her face, saying, "I'm going to get it this time. Let me think. Remember, no hints! Last name is Bauer…first name is…Erin!"

"Thank goodness," Erin said with sincerity, again likely imitating her mother, "I was worried there for a minute."