Derek stared at the films. He could see why a cautious surgeon would find the craniopharyngioma inoperable. It was pretty large and, like many similar tumors, it was placed between the carotoid artery and the brainstem. Because it was very close to the vision nerves, there was a real risk of damaging the vision. But Derek knew well that any parent would choose surgery if it meant the child would survive, no matter the risk of blindness.
After carefully examining the films for over an hour, Derek was confident that he could remove the tumor without damaging the boy's vision. He had some good experience with using an extended endonasal endoscope for a skull base craniotomy. He was glad that he had spent some time going reviewing all the equipment used for brain surgery at Seattle Grace. After he saw Grace didn't have the latest endonasal endoscope, he ordered one, so the hospital was prepared for this surgery.
He heard a knock at the door, and he said, "Come in."
Izzie walked in with another set of scans. "I have Sonia Chang's scans here. And Alberto Rodriguez is in the MRI room now. The two other patients will be here this afternoon."
"Good. I'm going to be able to operate on this one. I want to set the surgery up for first thing tomorrow, 7 a.m. So let's admit Jack Martin."
"Do you want me to tell the family? Or do you want to? They're in the waiting room."
"We can do it together. This is the good part. We get to give the family hope. I always loved this part of the job, but now I've been on the patient side, it means even more to me."
Derek and Izzie walked to the waiting room. Izzie went over to the family, two obviously worried parents and their fourteen-year-old son, and brought them to a private room off the main waiting room.
"Derek, this is Jack and his parents Nick and Joanne."
Derek smiled at them. "I'm glad to meet you. I have good news for you. I think Jack's tumor is operable, and I'm ready to admit him. I would like to schedule the surgery for tomorrow morning."
They looked shocked. "The other doctor said he didn't think anything could be done," murmured Joanne.
"He didn't think he could fix it, but our chief of surgery asked me to take a look at the case. I've just started working here, and I have done a lot of work with tumors that other surgeons think are inoperable. I had taken a look at the old scans and thought I might be able to help. That's why I had Dr. Stevens call you in to get new scans, to make sure the tumor was still operable. I didn't want to get your hopes up until I had seen the most recent scans and knew I could operate. And I've looked closely at the scans, and I have developed an approach. I'm going to use an endoscope, that way I can go through the nose to enter the skull base and remove the tumor completely. Because this surgery is through the nose, it doesn't leave a scar at all."
"We don't care about a scar; we just want to get the tumor out, so Jack can live," Nick said.
"No scar is fine, too, whatever, just as long as the tumor is gone," added Joanne.
"There are obviously risks with any surgery. The tumor is very close to the vision nerves, so it's possible that that Jack's vision could be damaged. I don't think that's likely, but you should know the risk."
"Mom, Dad, if I'm blind, can I get a dog?" asked Jack.
Nick laughed. "This boy has been after me to get a dog for years."
"Jack, I hope you're not too disappointed if you can see after the surgery," said Derek with a smile.
"I'd like being able to see, but I also want a dog."
"The dog is between you and your parents," said Derek.
"A dog is a big responsibility," said Joanne.
"Mom, I'm fourteen. I can walk a dog. I'm responsible."
"We'll think about it."
"I know that means no."
Derek smiled at Jack's insight. "Well, Jack right now, the important question is whether your parents are going to give consent for the surgery. You can worry about a dog after you recover from the surgery, if you have the surgery that is."
"Absolutely!" said Nick. "We are very grateful that you took a look at his scans and think you might be able to help."
"Dr. Shepherd is a great doctor," said Izzie.
"Thanks for the vote of confidence, Izzie," said Derek with a smile. "But it's up to Nick and Joanne."
"What about me?" asked Jack.
"You're still a minor, so your parents get to make the decisions. It's up to your parents whether to consult you. But I'm happy to answer any questions."
"What would you do if it were you?" asked Jack.
"I'd have the surgery," responded Derek immediately.
"I want to do it, Mom and Dad."
"We're doing it, Jack," responded Nick.
"Great. Dr. Stevens will take you to administration for admission, and she'll explain the pre-op procedures. I'll see you tomorrow morning at 7 a.m."
Derek left to look at the next set of scans. He was so happy to be working and having a chance to save some lives. And he hoped that helping others would be good karma for Chrissy.
Meredith watched Chrissy sleep. She knew that it was normal for even healthy three-year-olds to nap. Still, she found it comforting to watch her chest rise and fall as she breathed. She was glad to be alone with her daughter, knowing Derek had work to take his mind off of Chrissy's health. She had spent much of her life in the hospital, first as her mother's daughter and then as a medical student, intern, and now resident. She had even spent time as a patient, including her appendectomy. But she found being in the hospital as a parent of a patient very difficult. She kept thinking of how things could so easily go wrong.
She heard her phone buzz. She had put it on vibrate, thinking that would make it less likely to wake Chrissy. She looked at the number; it was unfamiliar, but she recognized 914 as a New York area number. She didn't want to disturb Chrissy, so she went into the bathroom. "Meredith Grey, here."
"Hi Aunt Meredith, it's Janie."
Meredith was puzzled. This was the first time one of Derek's nieces or nephews had called her directly. Carolyn had taken care of arranging the Skype calls with Chrissy. Meredith had overheard some of the conversations, but she couldn't place Janie. And this was also the first time any of Derek's family had called her Aunt. "It's nice to hear from you, Janie."
"I'm Lizzie's oldest. I go to the Rhode Island School for Design."
"Congratulations. That's a wonderful school for someone interested in art."
"Yeah, but there's a lot of homework."
"Homework is important. That's how you learn."
"Well, I have to do an animation project this week-end."
"I hope you find that fun."
"Yes, it's fun. Anyway, I had an idea for my homework assignment. I'd like to do a project for Chrissy."
"For Chrissy?"
"Yeah. For her bone marrow transplant day."
"I know that some people celebrate that day," Meredith started, but Janie cut her off.
"I'm not planning a birthday party, like some do. Just something to mark the occasion. It's a really wonderful that Uncle Derek wound up being a match."
"Yes, that's true."
"That's worth celebrating."
"What do you want to do, Janie?"
"I thought we could skype and I could play the animation for her. Or email it to you for you to play."
"That sounds fine."
"Well, the thing is I mentioned this to my family, and all the kids want to do something for Chrissy. Just homemade songs and art projects, nothing fancy."
Meredith smiled. Janie was anticipating her concerns. She must have spoken to someone else as a sounding board. "So who did you consult about this?"
"Grandma. She said Chrissy didn't want a birthday party in the hospital, and you didn't want her overwhelmed with gifts. I thought this, homemade art projects, could work."
Meredith smiled. Janie had made an offer that she couldn't refuse. "Okay, you've convinced me. You're being very sweet to Chrissy."
"Well, she is a Shepherd, and we help each other."
"That's wonderful." Meredith thought it was great that Derek's family was so supportive. But then she remembered that Molly and Lexie were happy to be tested to see if they could donate bone marrow, Susan had been helpful from the start, and even Thatcher had recently visited. So maybe Greys could also help each other. "Today is day minus 6. The transplant day is Wednesday, six days from now. You can email me or your Uncle Derek."
"I'll email you."
"I'll have your grandmother email all the children my email address."
"That's great, Aunt Meredith. Thank you for giving us the opportunity to help."
"You're welcome. I really appreciate you thinking of Chrissy."
"We were thrilled to have another cousin."
"Chrissy was thrilled to get to know all her Shepherd cousins."
"We hope to meet Chrissy soon."
"Janie, we'll have to see what the doctors say. But it would be great to meet you in person. Meredith looked out of the bathroom and saw Chrissy stirring. "Chrissy is waking up, so I have to go. It was great talking to you."
Meredith walked back to Chrissy's bedside and waited for her to wake up. Somehow, she was going to have to break the news to Izzie that she was letting Chrissy's cousins do something for the transplant day.
