Chapter 34 – Surgery
Amelia insisted on picking Addie up at the airport on Sunday afternoon. After all, Amelia would be stuck in bed for up to 12 weeks after her surgery. Rather than pick her up at the curb, Amelia parked the car and walked to the area where Addison would emerge from the gate area. She felt like a little girl anticipating Christmas, because she was about to see Addison.
"Amy!" Addison exclaimed as she ran toward Amelia. Upon reaching her, Addison set her hand on the baby bump and exclaimed, "Hi girls!" Then Addie looked up at Amelia and said, "They've been growing. That's great. Really great." Addison and Amy walked to the car arm in arm catching up on the last few weeks as if months had passed since their last visit.
That evening, Owen and Amelia hosted a small gathering at the house. Originally, they had considered going out to a restaurant. Once they considered all the kids who would be a part of the night, having dinner Chez Hunt made far more sense. Addison and Amy arrived to find that Derek had come early to help Owen. They were each drinking a beer as they barbequed on the back porch. Zola, Olivia and Bailey ran up and down the stairs as Ryder and Nolan pretended to be monsters trying to catch them. The scene was noisy, happy, and full of laughter.
Before long, Arizona and Sophia arrived and Annalisa was just minutes behind them. Karev, Jo, and Meredith soon arrived and rounded out the party. Jo had really wanted to find a reason not to come and hang out with uber-specialists and attendings, but Alex wore her down with his brown puppy dog eyes. Jo was tempted to play with the kids instead of interacting with the adults, but she knew that would only make her seem younger in all their eyes. Instead, she'd made Alex promise he'd attentive and seek her out if they ended up in different conversations.
Amelia had encouraged everyone to help themselves to drinks in the fridge, pointing out that she was going to make a nest on the couch and let everyone come to her. With all of her doctors present and an over-protective husband hovering, Amelia didn't stand a chance to get away with being on her feet or busily entertaining. Alex heeded the invitation, grabbing himself a beer then heading out to the back porch. Jo poured herself a glass of wine and paused before deciding where to go. She didn't want to Velcro herself to Alex too obviously, and she noticed Amelia was sitting alone.
"Can I join you, Dr. Shepherd?" Jo asked Amelia.
Amelia grinned and patted the couch, "Absolutely, but here, call me Amelia."
"I'll try," Jo offered, "but that might be a stretch for me."
"Aaahhhhhh, you can do it, Jo. I have faith in you," Amelia joked.
"Can I get you anything before I sit down?" Jo asked.
Amelia declined, then gazed out at the porch, chuckling, "Look at them. A brain surgeon, trauma surgeon and pediatric surgeon. Brilliant men who hold lives in their hands daily. But today, they pretty much look like idiots as they stand there joking and the steak in the back is engulfed in flames."
"Should I tell them?" Jo laughed in response.
"Hell, no," Amelia responded with expressive brows, then hollered to the others, "Addy, Mer – look out there at the smart guys. See what I see?" Annalisa and Arizona were sitting outside on another part of the porch, deep in conversation, and didn't hear Amelia.
"Oh...my...God…they just never grow up do they?" Addison exclaimed as she shook her head.
Meredith took a sip of wine, smiled, and yelled, "Who likes their steak well done?!"
Derek looked toward Mer with confusion as Karev and Owen had moved on to the shore, skipping rocks into the water. Derek rolled his eyes then ran over to squelch the fire. He yelled down to Owen and Alex who, rather than helping their buddy out, busted out laughing. Derek responded by pointing at them and insisting that they could share the overly well done cut.
Alex glanced inside curiously to check on Jo. She smiled when she caught his eye. He winked and raised his beer as if to toast her.
Addison and Meredith joined Amelia and Jo on the couch as Amelia grinned and shared, "Look at that! I just love seeing Alex being adorable. It happens so seldom at the hospital."
Addison looked up to the ceiling trying not to respond, and Amelia stretched out her foot and nudged Addison's leg. Meredith stated with assurance, "He's always been a big softie deep down with a hard exterior façade. That's our Alex. He's like those yummy strawberry candies with a thick, hard outer shell and all soft and mushy inside."
Amelia chimed in, "or like Rolos or Peanut Butter cups."
"Or like Zotz…remember those? You know, a little zing and surprise inside? That's Alex," Addison kidded suggestively.
"If we're sticking to candy metaphors, I'd say he's more like a blow pop, very hard but yummy" Jo mused realizing immediately how her observation, intended to be innocent and silly, sounded nasty.
As everyone laughed, Addison prodded, "And what if we're not sticking to candy metaphors?"
"Hmmm," Jo coyly paused and offered with a cat-that-ate-the-canary grin, "I'd say a really large, perfectly-sized, ripe banana, but that's all you're getting from me."
The rest of the women in the room burst into hysterical laughter as Owen, Derek and Alex all looked toward them with complete confusion.
Alex stepped through the open door and grinned, "What's so funny?"
Addison turned to face Alex and shook her head as she laughed, "Oh nothing."
"Yep, nothing. Nothing at all," Meredith affirmed with a giggle.
"Actually, it was something Jo said," Amelia joked with a smile. Jo's mouth and eyes opened wide as she glanced at Amelia for calling her out.
Alex walked further inside and grabbed another beer out of the fridge. He threw some chips, dip, and a huge scoop of mixed fruit on a plate. As walked over to Jo, leaning down to kiss her, he flirted, "Something you said, huh? What's so funny?"
Jo smiled sweetly at Alex, saying nothing, as he poked a piece of melon with his fork and put it In his mouth.
Seemingly out of the blue, Addison observed, "You like those chunks of melon, huh, Alex?"
He shrugged and nodded casually as he poked a piece of banana and moved his fork toward Jo's mouth, "Want some?"
"Always. I love bananas," Jo grinned mischievously as the others tried to hold back laughter.
Sensing there was a joke in the room to which he was not privy, Alex strutted back out to the porch and approached Arizona and Annalisa. The women appeared to be sharing a deep conversation.
"Hey, I thought there was no strategizing tonight," Alex pointed out.
"We're talking about shoes, Alex," Arizona responded dryly. "What heel height works best for you?"
"Well…the higher they are, the sexier they are. As long as the chick can balance on them, I'm good," Alex shared.
Arizona rolled her eyes and corrected, "No, you're crude."
"Yeah, but you already knew that," Alex retorted before taking another drink of his beer.
"So, Annalisa," Arizona suggested, "shall we talk about surgical strategies? It might keep Alex away."
The rest of the evening was filled with quips, laughter, and conversation. The party had been the ideal pre-op event for both Amelia and Owen. Barring the one extreme steak, the food was wonderful. The kids had run and played until they dropped like exhausted puppies in the TV room. Jo found that simply chatting with the attendings and being herself minimized her feelings of intimidation.
After everyone had left and Addison had fallen asleep in the guest room, Owen snuggled up next to Amelia on the couch. His back leaned against the kitchen-side of the sofa with his legs extended toward the water. Amelia was perpendicular to him, facing the water as her head rested on his lap and he stroked her hair.
"Everything changes tomorrow," Amelia sighed thoughtfully.
Owen cocked his head and looked down at his wife, "Is that good, bad, or somewhere inbetween?"
"Yes," Amelia chuckled. "Just different. Tomorrow's the turning point. The surgery could be a phenomenal success and the girls could stay inside for weeks, or, worst case scenario…"
"Shhh, shhhh," Owen whispered, "No worst case scenarios. We're not going into that OR with worst case scenarios on our radars."
Amelia smiled up at Owen and nodded, confirming, "You're right."
~~~~~~~~~~~~~~~'
Owen and Amelia reported to the hospital early Monday morning, leaving the kids in Lynne's care. Being on the other side of the process meant reporting to the hospital at 5:30am for an 8:00am surgery rather than arriving around 7:30am to scrub and quickly greet the patient. They checked in at the front desk rather than heading directly to the lounge or to Owen's office. The morning's paperwork consisted of filling out insurance and medical history forms rather than chart notes. The couple waited in uncomfortable waiting room chairs reading outdated magazines between having pre-op bloodwork drawn, chatting with the billing coordinator, and turning in some paperwork. This side of the table was surprisingly unfamiliar to both of them.
A CNA stepped into the waiting area, looked down at the papers in her hand, and called out, "Mrs. Shepherd?" Owen and Amelia smiled at one another and walked toward the CNA.
"Actually, it's Dr. Shepherd, but that's ok," Amelia clarified.
The CNA apologized and looked at Owen with a reassuring grin, "Actually, Mr. Shepherd, we'll come find you when your wife is settled in. You'll have a chance to see her just before her surgery."
Owen echoed his wife's sentence, "Actually, it's Dr. Hunt, and I'll be in the OR with the surgeons." He held out his hand and introduced himself with a reassuring smile, "I don't believe we've met yet. I'm Owen Hunt, Chief of Surgery."
"I'm Polly," she said as she grasped Owen's hand. After releasing her hand, she continued, "Oh…my. I'm sorry, doctors. None of that is noted here. I apologize," the CNA responded looking scared and anxious.
Grinning, Owen reassured her, "Really, it's an honest mistake." The CNA, intimidated by having her boss' boss' boss' boss standing in front of her, lost track of her routine. Owen, reading Polly's confusion, asked, "Where to next? We're not used to this side of the OR?"
"Right," Polly nodded. She grinned at Amelia and led her to the scales with a silly and awkward smile, "Everyone's favorite stop." Polly likely said this line to at least 20 people a day.
After recording Amelia's weight, Polly led them to a room. "I have a note here that you've been assigned to a side room rather than the regular curtain beds, so we'll head this way." Amelia looked at Owen, who was behind the special treatment. He smiled and shrugged as he followed behind the women.
Polly turned the corner, bent down to grab a gown from the bottom drawer of the exam table. "If you could change into the gown and remove all of your jewelry…"
Interrupting, Amelia set her hand on Polly's arm, "I know the details on this part."
"Of course you do," Polly grimaced as she shook her head. "I'll be back in a minute to take your vitals."
Owen sat in a side chair and checked the emails on his phone until he stood to tie the back of Amelia's gown for her. As he typed and tapped, he wondered aloud, "Why don't we allow family members back until the patient has changed? Seems ridiculous because then the assistant is walking to the waiting area twice instead of once. Aren't they busy enough? Why couldn't we ask the patient for his or her preference? Or have them check a box on one of the 6,000 forms we make them fill out? Do you have a piece of paper, Mia? I'm gonna keep notes today."
Amelia grinned broadly as she settled herself on the bed. "You're precious."
Owen looked up, confused, "Huh?"
"You're inability to just be a normal husband whose wife is having surgery. It's cute. And, yes, there's a pad of paper about the size of a scrip pad in my purse," Amelia explained.
Smiling and slightly blushing, he offered, "I could take your vitals too, you know?"
Amelia oooh'd and ahhhh'd as she shared an exaggerated response. "Oh, Dr. Hunt," she panted and cooed, "can we play doctor?" The couple laughed with one another until Amelia rubbed her hands along her arms.
"Are you cold?" Owen asked. "It's freezing in here." He stood to go into the hallway to grab a heated blanket as he held his index finger up in the air, saying, "Another item for my improvement list." Returning with two thin hospital blankets, he wrapped one around Amelia's back and placed one around her legs, belly and chest.
"MMMmmmmmmm, where's my comment card?" Amelia joked, "I'm giving that sweet red-headed male nurse's assistant a star for bringing me warm blankies." Hugging his wife tightly, Owen chuckled at her silly words.
As he stood and swayed back and forth from right to left hugging his wife, the CNA knocked softly and proceeded inside. Owen stepped away and sat down as the CNA announced, "Dr. Shepherd, let's get your vitals." As she worked, she also confirmed the information on the ID bracelet and then placed it on Amelia's wrist.
A maternity RN, Jane, walked in as Polly scurried about. She greeted the couple warmly and with hugs, "Dr. Hunt, good morning. What's it like on this side of the OR?"
"Good morning, Jane. It's strange," Owen responded to the RN as she hugged Amelia and began placing leads on her belly bump and chest.
"I normally explain what all this does. Would a refresher be helpful since maternity isn't your specialty?" she asked.
Amelia pursed her lips and moved them to one side before responding with a wink, "Nah…they even let us trauma and neurosurgeons use leads…but only with supervision."
The anesthesiologist, Dr. Adams, entered as the pre-op frenzy escalated. "Hi Amelia! Owen. No food since when?"
"Ummmm….an hour ago?" Amelia kidded. The anesthesiologist folded his arms and raised his eyebrows as Amelia clarified, "About 9pm last night at the latest."
Adams entered the time into his iPad and asked, "How about meds? Tell me about your medications and when you last took them." Amelia answered his question, realizing how impersonal the questions felt even when a friend was asking. "Good," Adams affirmed as he continued, "Any sensitivities to anesthetic?"
Amelia shook her head but reminded the doctor, "I'm a recovering addict – oxy and other pills."
"I remember, but it's always good to repeat that information. Here's my usual routine for your situation," Dr. Adams explained as if she was any other patient. Owen walked over and stood beside her so he could hear the details. "Rather than a narcotic to relax you, here's an Ambien to start the process. You won't feel goofy, but it will make you pretty drowsy. Once we're in the OR, general anesthesia is no problem at all, although an epidural is also an option. Post-op, tramadol is your best bet since it's non-narcotic. I'll give you a small dose of buprenorphine only if absolutely necessary. It has no narcan and is only a partial opioid. I'll stay away from Demerol, Stadol, opioids. How's that sound to you?"
Amelia shook her head, "No buprenorphine. No way."
"What if tramadol isn't cutting it?" Owen asked her, concerned about her potential pain.
"Doesn't matter. No opioids, no narcotics whatsoever," Amelia insisted.
"Amelia, I understand your reluctance, but we also have to consider your BP and the babies," Dr. Adams pointed out, "If you end up in tremendous or uncontrolled pain, it will affect the babies. That could lead to all sort of complications including pre-term labor."
Raising her eyebrows and boring her eyes into Adams' gaze, Amelia insisted, "Then let's do a repeat epidural if it comes to that."
Adams nodded and agreed, "You drive a hard bargain, Amelia. I admire your dedication to your recovery. I'll see you in the OR in just a few minutes. Owen, are you joining us?"
"Yeah, I'll be in there," Owen replied.
"You'll want to scrub now. Otherwise, you'll be doing so as the surgery begins," Adams advised.
Owen nodded, "Good to know. I'll be down there momentarily." Stroking her hair, Owen kissed Amelia and whispered in her ear, "I'll be right beside you. I love you."
As Addison and Annalisa entered the room, Amelia whispered, "I love you too…so much."
"Owen, now's a great time to scrub," Addison ordered. Owen smirked and nodded as he subtly blew a kiss to Amelia. "So, Amy, you feeling ok? Any questions?"
"No," Amelia uttered softly, starting to become sleepy from the Ambien.
Addison nodded, "Just to summarize, we're going to monitor both babies throughout the process. We will use ultrasound to locate Asha's position and location then I'll enter as close to here as possible," she said as she traced an area on Amelia's abdomen and drew a line with a Sharpie. "The initial portion of the surgery is much like a slow-motion C. Then, the uterus will be cut perpendicular to your abdomen. Asha will be removed from your uterus only insofar as necessary to access the surgical area. She will be medicated and will not feel anything. Once her surgery is complete, we'll place her fully back in your uterus and wait for positive signs before fully closing. I'll do all I can to avoid birth, but we'll attempt a delayed interval delivery if Asha needs to be delivered. I'll attempt to keep Madeline in the womb if at all possible. Dr. Karev will enter and be standing by in the OR once I begin the second set of cuts. Dr. Robbins will back up Dr. Karev and care for Madeline if she ends up being delivered. Everyone has their spot, everyone knows their job, and we are a strong and capable team." Addison concluded, fairly sure that Amelia had heard only about 1/3 of her explanation. Amelia closed her eyes as Addie nodded to Annalisa and directed, "Ok, let's go. Let's get her in there."
Owen and Dr. Adams were in the OR waiting when Amelia was rolled in. Adams was double and triple checking supplies and dials as Owen paced the room, clasped his hands behind his neck, and took enormous breaths. Amelia had approved OR 1 and use of the gallery so the med students and other doctors could watch and learn from the surgery. Looking up as he heard the glass door into the OR slide open, Owen smiled and walked quickly to Amelia. He invited himself to help wheel her to the table and, unintentionally and out of habit, instructed, "On my count. 1 – 2 – 3."
Addison buzzed into the OR, stating, "Old habits are hard to break, but that's your last order, Hunt." Hunt looked over, nodded affirmatively and mumbled an apology before grasping Amelia's head and kissing her through his mask. She smiled and slurred a response. Owen rested his cheek on hers briefly then moved out of the way for Adams. Adams began working on Amelia right away so Addison and Annalisa could begin the minute they entered the room. He placed a mask on her, she was barely awake enough to count, and was easily sedated. Adams was intubating just as Addison and Annalisa entered for gowns and gloves.
"How are we doing, everyone?" Addison asked. "Ready?" Everyone muttered agreement and took their places around or near the table. "Owen, do you want to be able to see the cuts or shall we tent high?"
"I want to see it all," Owen stated firmly.
As the nurse set up the field, Addison warned, "That will be fine as long as I don't hear your voice or sense an overbearing presence. Remember, I'll ask you once if I need you to step out." Owen nodded, feeling strange being bossed around and given firm limits in an OR.
In the gallery, Derek leaned over to Meredith and quipped in a whisper, "She just loves bossing powerful men around." Meredith playfully shoved him and he covered his mouth as he laughed out loud. He continued, "Really, though, she's the perfect person to command that space right now." Meredith just gazed at her husband with a grin and a slowly shaking head.
Arizona moved the transducer around to locate the baby and her position. Once found, she softly offered, "There's our Asha. Hi baby."
"10 blade," Addison called out as she extended her hand, "Let's get some suction." The resident on the other side of the table suctioned as ordered and assisted as needed. "Thank you for joining us, Dr. Karev. You've arrived as if on cue."
Karev chuckled and walked over to where he'd wait in case he was needed, "Why did I just have a flashback to residency?" He conferred with his nurse and ensured he had everything set out where he needed it. He mumbled a few instructions to the nurse and asked for an additional instrument, then thanked the nurse for her set up and assistance.
"How are Madeline's readings?" Addison asked Annalisa.
Annalisa responded, "Calm and strong. Asha's challenging to read right now."
"I'm right above her on the uterus. Let's get those tiny leads ready to place. She'll be accessible in a few seconds," Addison explained. "How's Amelia?" The anesthesiologist confirmed strong readings and Addison responded, "Great BP – glad to see that. Let's keep a close eye on the BP – she's had some swings in the last few months."
Addison cut the uterus and advised clearly, "Nobody flinches, nobody moves. Here she comes." Addison reached in and cradled the baby, ensuring she was face down in the amniotic fluid so she would not begin trying to breath on her own. Addison exclaimed, "Daddy, look at all that dark hair on your girl! Vitals are stable all around. You want to touch her quickly?"
"Really?" Owen asked. Addison nodded. Owen stood up and approached the surgical field. Gently caressing Asha's tiny shoulder, Owen uttered softly, "Hi, baby girl. Beautiful, amazing Asha." As Owen spoke, the baby responded by moving slowly. A few tears of joy fell from his eyes. Addison caught his eye and nodded as a sign for him to sit back down.
"You can see the area we'll be adjusting," Addison explained. "Did anyone notice anything of significance when Dr. Hunt spoke to the baby?"
The resident piped up, "The baby's legs moved. That's a hopeful sign."
"Yes it is. Did you notice it, Dr. Hunt?" Addison asked as Owen responded with a nod.
Arizona stepped in as Addison held Asha face down to position her for surgery. Arizona and Annalisa worked carefully and quickly for just over an hour. Karev moved to the table to assist as needed and to be close by if the baby was delivered. Arizona assured Owen, "Chief, everything is smooth. Her cord will be completely in place momentarily."
"Baby is back in place. Let's check umbilical cord placement," Annalisa ordered.
Addison answered, "Looks good," as she removed her hands from the womb and assisted Annalisa in beginning to close.
Once all the initial stitches were in place, Addison sighed with relief as she stepped back to stretch, "Let's pause for some readings, make sure everyone is stable." Addison gazed over at Owen, "Pretty surreal, huh?"
"Ummm…yeah…most definitely," Owen responded as he blinked repeatedly and looked up at Addie with gratitude.
"Dr. Montgomery, Madeline's agitated," Arizona reported. "Chief, seriously, come over here and talk to her. Your voice may calm her," she ordered.
Owen stepped over quickly and placed his gloved hand over the skin covering Maddy, "Dad talked to your sister, so now it's your turn? I'll bet you're my feisty red head. Shhhh….shhhhhh….shhhh. Settle down there baby girl."
Maddy slowed a bit but not as much as the surgeons desired. Owen asked, "When the kids feel for the babies' kicks, the girls usually stop or slow if the kids press on Amelia's bump."
"Try it," Annalisa and Addison declared simultaneously. Owen pressed just a bit and kept talking. Maddy slowed down.
"Good, stay right here, Chief, in case she ramps up again," Arizona ordered.
Addison confirmed Amelia and Asha's readings before proceeding to close. She provided orders for recovery, medications, and ongoing monitoring. "Owen, are you going to recovery or do you want to take a few minutes to recap?"
"I'll stay with Amelia. We can chat later when she can be part of the conversation too." Owen stated.
Before leaving to scrub out, Addison announced. "Excellent work, team. Excellent. Great surgery." Owen approached her and hugged her tightly, whispering a thank you to her.
Karev patted Owen on the shoulder and assured him that he'd remain at the hospital for the next few hours and stay on call just in case. Arizona and Annalisa departed next, after hugging Owen and speaking to him very briefly with their positive impressions.
Owen walked with Amelia's bed to recovery. As they stopped in a bay, he grabbed a stray chair and waited for Amelia to rouse. He placed his hand gently over Maddy and talked to the babies as he periodically reviewed the readings on Amelia's monitors.
Thirty minutes later, Amelia's heavy, sedated eyes fluttered. Owen leaned in and quietly shared, "Everything went well, Amelia. No scares, no problems. Both babies are still in utero. Asha's surgery was successful." Amelia offered a small smile as she faded in and out of the anesthesia and grasped Owen's hand in hers.